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|本期目录/Table of Contents|

改良Morrow手术治疗21例肥厚梗阻型心肌病临床分析

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第4期
页码:
467-469
栏目:
临床研究
出版日期:
2015-04-20

文章信息/Info

Title:
Clinical analysis of modified Morrow’s procedure in 21 patients with hypertrophic obstructive cardiomyopathy
作者:
杨金保; 梁宏亮; 孟 欣; 刘金成; 俞世强; 刘丽文; 张金洲
(第四军医大学西京医院心血管外科,陕西 西安 710032)
Author(s):
YANG Jin-bao;  LIANG Hong-liang;  MENG Xin;  LIU Jin-cheng;  YU Shi-qiang;  LIU Li-wen;  ZHANG Jin-zhou
(Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China)
关键词:
心肌病; 肥厚梗阻型; 改良Morrow手术; SAM征; 肥厚梗阻型心肌病(HOCM)
Keywords:
hypertrophic obstructive cardiomyopathy;  modified Morrow's procedure;  systolic anterior motion
分类号:
R542.2
DOI:
-
文献标识码:
A
摘要:
目的 评价改良Morrow手术治疗肥厚梗阻型心肌病(HOCM)的临床疗效。方法 回顾性分析我院2013年8月~2014年7月应用改良Morrow手术治疗的21例HOCM患者临床资料。所有患者均为药物治疗效果不佳，其中男9例，女12例，年龄22~64(45.3±11.9)岁。所有患者均行改良Morrow手术，包括扩大的肥厚心肌切除和游离肥厚的二尖瓣前乳头肌，其中2例患者同时行二尖瓣前叶折叠。对比研究所有患者手术前后左室流出道梗阻、二尖瓣功能和临床症状改变，评价改良Morrow手术疗效。结果 全组21例患者无死亡。术中切除心肌质量8.5~22.8（14.9±3.8） g。术中Ⅲ度房室传导阻滞1例，安置心脏永久起搏器。术后患者左室流出道压差显著降低〔术前（101±41）mmHg vs.术后（10±8）mmHg〕（P<0.01），左室流出道最狭窄内径显著增宽〔术前（5.0±2.1）mm vs.术后（16.6±3.6）mm〕（P<0.01），左房内径明显减小〔术前（47±5）mm vs.术后（42±5）mm〕（P<0.01），二尖瓣返流量显著减少〔术前（5.9±3.7）ml vs.术后（1.8±1.5）ml〕（P<0.01）。18例术前SAM征阳性患者术后SAM征均消失，19例患者胸闷、气短症状消失，90%患者心功能为Ⅰ级。结论 改良Morrow手术能够有效解除左室流出道梗阻，改善二尖瓣功能，是治疗药物无效HOCM的有效手段。
Abstract:
AIM To evaluate the clinical effects of modified Morrow’s procedure on patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS From August 2013 to July 2014, 21 HOCM patients[9 males and 12 females, ages ranging from 22 to 64 years, mean (45.3±11.9) yearrs]underwent modified Morrow’s procedure including extensive myectomy and isolation of mitral papillary muscle. Two patients underwent plication of the anterior mitral leaflet. All patients underwent echocardiography before operation and discharge to examine the location and degree of left ventricular outflow tract(LVOT)obstruction, mitral valve apparatus and associated cardiovascular malformation. Transesophageal echocardiogram (TEE) was done in each patient introperatively. RESULTS No deaths occurred in hospital. The weight of myocardium resected ranged from 8.5 g to 22.8 g with a mean of (14.9±3.8) g. III° heart block occurred in one patient and a permanent pacemaker was implanted before discharge.Systolic anterior motion (SAM) disappeared in all cases.Chest pain and shortness of breath disappeared in 19/21 patients. Compared with those pre-operatively, pressure gradients of LVOT obviously decreased[(101.3±40.9) mmHg vs.(9.6±7.5)mmHg, P<0.01],LVOT diameter enlarged significantly[(5.0±2.1) mm vs.(16.6±3.6) mm, P<0.01],size of the left atrium decreased remarkably[(47.0±5.4) mm vs.(41.8±5.3) mm,P<0.01]and mitral regurgitation improved obviously[(5.9±3.7) ml vs.(1.8±1.5) ml, P<0.01].Heart function improved in all patients postoperatively and 90% of the patients were in NYHA functional class I with no severe complications.CONCLUSION Modified Morrow’s procedure is an effective method for treatment of hypertrophic obstructive cardiomyopathy. After operation, LVOT obstruction can be relieved in all patients and mitral valve function can be significantly improved.

参考文献/References

[1]Maron BJ,Gardin JM,Flack JM,et al.Prevalence of hypertrophic cardiomyopathy in a general population of young adults:echocardiographic analysis of 4111 subjects in CARDIA study[J].Circulation,1995,92(4):785-789.
[2]Maron BJ.Hypertrophic cardiomyopathy: a systematic review[J].JAMA,2002,287(10):1308-1320.
[3]Gersh BJ,Maron BJ,Bonow RO,et al.2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Am Coll Cardiol,2011,58(25):e212-e260.
[4]布朗威 E.心脏病学[M].陈灏珠,译.北京:人民卫生出版社,2000:1288-1290.
[5]Maron BJ,McKenna WJ,Danielson GK,et al.American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy.A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines[J].Am Coll Cardiol,2003,42(9):1687-1713.
[6]Aronow WS,Ahn C,Kronzon I,et al.Prognosis of congestive heart failure in patients aged>or=62 years with unoperated severe valvular aortic stenosis[J].Am J Cardiol,1993,72(11):846-848.
[7]Ommen SR,Maron BJ,Olivotto I,et al.Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy[J].Am Coll Cardiol,2005,46(3):470-476.

备注/Memo

备注/Memo:
收稿日期：2014-09-27.
通讯作者：张金洲，副主任医师，主要从事肥厚梗阻型心肌病外科治疗和微创治疗心血管疾病研究 Email：jinzhou@fmmu.edu.cn
作者简介：杨金保，住院医师，硕士 Email：yangjinbao120@163.com
更新日期/Last Update: 2015-04-22