肥厚型梗阻性心肌病合并左室心尖部室壁瘤同期外科手术治疗的远期结果

目的研究肥厚型梗阻性心肌病合并左室心尖部室壁瘤的外科治疗效果。方法回顾性分析2012年10月至2017年7月接受外科手术治疗的8例肥厚型梗阻性心肌病合并左室心尖部室壁瘤的病例资料。男6例,女2例;年龄14~73岁,平均(38.6±19.9)岁。所有患者均接受室间隔心肌切除术和室壁瘤切除术治疗。采集患者院内的病历资料,并通过门诊及电话随访记录患者情况。结果术前全部患者均通过冠状动脉造影排除了固定的冠状动脉狭窄病变,6例患者合并左室中部梗阻,3例有室性心动过速病史。全组病例无手术死亡,4例患者治疗过程中有不同程度的并发症。术后心脏超声提示LVOTPG、IVS、LAD、MI程度与术前比较均有显著性改善(P<0.05),但术后超声提示仍有4例患者心尖部可见室壁瘤样结构。所有患者随访(47.4±24.0)个月,随访率100%,术后NYHA心功能分级明显好于术前(P=0.001),远期死亡1例。结论肥厚型梗阻性心肌病合并左室心尖部室壁瘤的患者病情危重,同期行室间隔心肌切除术和室壁瘤切除术临床结果可以接受,但一些问题仍有待进一步研究。

Long-term Results of Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Apical Aneurysm

Objective To assess the surgical outcome of hypertrophic obstructive cardiomyopathy combining left ventricular apical aneurysms.Methods A retrospective analysis was performed in 8 cases of hypertrophic obstructive cardiomyopathy with left ventricular apical aneurysm who were surgically treated in our hospital between October 2012 and July 2017.There were 6 males and 2 females with an average age of(38.6±19.9)years(range,14-73 years).Ventricular septal myectomy and resection of left ventricular apical aneurysm were performed in all the patients.Data were collected from medical records and the patient recent conditions were assessed through outpatient visits and telephone interview.Results Coronary stenosis was excluded by preoperative coronary angiography in all patients.There were 6 patients with middle ventricular obstruction and 3 with a history of ventricular tachycardia pre-operative.No perioperative death were found,but 4 cases got some complications during the treatment.LVOTPG,IVS,LAD and MI was significantly improved after surgery(P<0.05).Left ventricular apical aneurysms were still identified in 4 patients by postoperative echocardiography.The mean follow-up time was(47.4±24.0)months,with a 100%follow-up rate.There was one sudden cardiac death during follow-up.The NYHA cardiac function grading was significantly improved after surgery(P=0.001).Conclusion Patients with hypertrophic obstructive cardiomyopathy and left ventricular apical aneurysm are in critical condition,the surgical results are acceptable,but some problems still needed further study.