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目的:总结肥厚室间隔切除术治疗肥厚梗阻性心肌病的手术效果,探讨外科治疗策略。方法:2002年3月至2010年10月,外科手术治疗33例肥厚梗阻性心肌病病人。其中男16例,女17例;年龄13～59岁,平均(42.7±13.6)岁;左室流出道压差(LVOTGP)70～120 mmHg(1 mmHg=0.133Kpa),平均(95.0±22.6)mmHg。其中合并二尖瓣关闭不全24例,主动脉瓣关闭不全7例,升主动脉增宽3例,冠心病2例。手术在全麻低温体外循环下完成,按常规经主动脉切口行室间隔心肌切除术,同期完成二尖瓣置换术(MVR)7例,二尖瓣成形术(MVP)7例,二尖瓣、主动脉瓣成形术(MVP+AVP)5例,二尖瓣、升主动脉成形术3例,二尖瓣、主动脉瓣成形、冠状动脉旁路移植术(MVP+AVP+CABG)2例。分析比较病人术前超声心动图(UCG),术中经食管心脏超声(TEE),以及术后1周、3月、6月、1年超声心动图结果。结果:手术死亡1例(3.0%,1/33例),主要死因为严重低心排综合症以及多脏器功能衰竭。二次开胸止血1例(3.0%,1/33例)。术中经食管心脏超声示所有病人二尖瓣前叶收缩期前向运动现象(SAM征)消失。存活病人手术效果良好,解剖狭窄解除,峰值压差降低,SAM现象基本消失。远期随访生存病人症状消失,生活质量明显改善,心功能I～II级,无远期死亡、并发症或再次手术。结论:外科治疗肥厚梗阻型心肌病具有良好的手术效果。了解病生理过程、术中仔细探察、手术切除彻底是手术成功的关键。
Objective: To summarize the surgical results of hypertrophic ventricular septal resection for hypertrophic obstructive cardiomyopathy and to explore the surgical treatment strategy. Methods: From March 2002 to October 2010, 33 patients with hypertrophic obstructive cardiomyopathy were treated surgically. There were 16 males and 17 females, ranging in age from 13 to 59 years (mean 42.7 ± 13.6 years). LVOTGP was 70 to 120 mmHg (1 mmHg = 0.133Kpa) mmHg. Among them, 24 cases were complicated with mitral regurgitation, 7 cases were aortic insufficiency, 3 cases were ascending aorta and 2 cases were coronary heart disease. The surgery was performed under hypothermic cardiopulmonary bypass with general anesthesia. Conventional aortic incision and ventricular septal myocardial resection were performed. Seven cases of mitral valve replacement (MVR), seven cases of mitral valvuloplasty (MVP) and two cases of mitral valve replacement , 5 cases of aortic valve plasty (MVP + AVP), 3 cases of mitral valve, ascending aorta, 2 cases of mitral valve, aortic valve forming and coronary artery bypass grafting (MVP + AVP + CABG) . Echocardiography (UCG), intraoperative transesophageal echocardiography (TEE), and postoperative 1 week, 3 months, 6 months and 1 year echocardiographic results were analyzed. Results: One patient died of surgery (3.0%, 1/33 cases). The main causes of death were severe low cardiac output syndrome and multiple organ failure. One case of secondary thoracotomy (3.0%, 1/33 cases). Intraoperative transesophageal echocardiography showed mitral valve anterior systole in all patients before the phenomenon of movement (SAM sign) disappeared. Survival patients with good surgical results, the lifting of anatomical stenosis, peak pressure drop decreased, SAM disappeared. Long-term follow-up survival of patients disappeared symptoms, quality of life improved significantly, cardiac function I ~ II level, no long-term death, complications or reoperation. Conclusion: Surgical treatment of hypertrophic obstructive cardiomyopathy has good surgical results. Understanding of disease physiology process, intraoperative careful exploration, surgical resection is the key to successful surgery.