【摘要】 目的:探讨肥厚型梗阻性心肌病(HOCM)的外科手术疗效。方法:回顾性分析2010年6月至2013年12月,我院外科行改良扩大Morrow手术治疗65例HOCM患者的临床资料,其中男性40例(61.5%),年龄18~70岁,平均(48.4±11.5)岁,术前所有患者药物治疗后临床症状仍明显,术前左心室流出道压差(LVOTG)为62~140mmng(1mm Hg=0.133k Pa),平均(85.5±28.6)mmm Hg,65例患者均有收缩期前向运动(SAM征)。全部患者均接受室间隔心肌切除术(改良扩大的MORROW手术),其中8例(12.3%)合并心脏瓣膜手术,1例(1.53%)合并冠状动脉旁路移植术。术后观察手术疗效。结果:全组无住院死亡,手术无瓣叶损伤及室间隔穿孔发生。手术后左心室流出道压差(LVOTG)、室间隔厚度(IVS)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)以及二尖瓣反流(MI)程度较术前均降低,差异有统计学意义(P<O.05)。术后3例发生完全房室传导阻滞,完全性左束支传导阻滞7例,左前分支传导阻滞3例。术后所有患者均随访,随访时间6~35个月,55例(84.6%)患者的临床症状消失,其余10例患者症状较术前明显减轻。随访期患者纽约心功能分级(NYHA)为I-Ⅱ级。结论:室间隔心肌切除术可以解除左心室流出道的梗阻,消除或明显改善患者临床症状,具有满意的近中期疗效。更多还原

【Abstract】 Objective: To analyze surgical procedures and clinical results of surgical treatment in patients with hypertrophic Obstructive cardiomyopathy. Methods: We retrospectively examined 65 consecutive patients with Hypertrophic obstructive cardiomyopathy operated in our institution from 2010 June to 2013 December. Male 40 cases( 61. 5%),age 18- 70( 48. 4 ± 11. 5) years. all the patients had drug-refractory symptoms and a left ventricular outflow tract of gradient 62- 145( 85. 5 ± 28. 6) mm Hg by Doppler echocardiography. All patients had the systolic anterior movement of the mitral leaflet.( SAM). All patients underwent septal myectomy( modified MORROW procedure) and 8 patients( 12. 3%) combined valvular surgery,1 patient( 1. 53%) combined coronary artery bypass grafting. Postoperative clinical effect were observed. Results: There was no in-hospital death. No valve was injuried and no patient had ventricular septal perforation. Postoperative LVOT gradient,Interventricular septum( IVS),Left ventricular end-diastolic( LVEDD),Left ventricular ejection fraction( LVEF) and Mitral regurgitation( MR) were significantly lower than preoperative values( P < 0. 05). Complete atrioventricular block occurred in 3 patients,complete left bundle branch block occurred in 7 patients,left anterior division block in 3 patients. The follow-up time were 6 ~ 35 monthes. During the follow-up time,the clinical of symptoms of 55 patients were diminished and other patients’ symptoms were ameliorated significantly. All the patients had a New York Heart Association functional class I / Ⅱ during the follow-up. Conclusion: Surgical septal myectomy can eliminate left ventricular outflow tract obstructive and relief symptoms obviously. The early and mid-term outcomes were satisfactory.更多还原