肥厚型梗阻性心肌病合并二尖瓣自身病变致二尖瓣关闭不全的外科治疗

目的 评价外科治疗肥厚型梗阻性心肌病合并二尖瓣自身病变致二尖瓣关闭不全（MR）的临床效果.方法 2000年1月至2009年12月我科收治13例肥厚型梗阻性心肌病合并二尖瓣自身病变致二尖瓣关闭不全患者.所有患者均行室间隔心肌切除术（改良marrow术）,7例行二尖瓣置换术（MVR）,6例行二尖瓣成形术（MVP）.3例患者再次转机,1例因左室流出道狭窄解除不满意,1例有残余MR行MVP,1例残余MR行MVR.结果 全组体外循环时间（131.9±61.8）min,主动脉阻断时间（92.7±39.8）min.超声心动图（UCG）显示术后左房大小、左室流出道压差均较术前有显著下降.MVP组有2例因再次MR行MVR.结论 此类患者理想的手术方法是充分切除肥厚的室间隔肌肉,自身有病变的二尖瓣可考虑行MVR或MVP,如果条件许可,应首选MVP.

Clinical experience of surgical treatment on mitral valve abnormalities in hypertrophic obstructive cardiomyopathy

Objective To evaluate the surgical treatment of mitral regurgitation （MR） in Hypertrophic obstructive Cardiomyopathy （HOCM） with anomalous mitral valve（AMA）. Methods The clinical data of 13 patients of HOCM with AMA from Jan.2001 to Dec.2009 were analyzed retrospectively. All patients had extend septal myectomy （modified Marrow procedure）,7 patients had mitral valve replacement （MVR）, 6 patients had mitral vavle repaire（MVP）.3 patients had repeat cardiopulmonary bypass（CPB ）, 1 for residual pressure gradients through left ventricule out tract （LVOT）,2 for residual MR. Results The time of CPB and aortic occlusion were 73-290 （131.9＋61.8）rain and 53-195 （92.7＋39.8）min. The sides of left atrium and the pressure gradients through of LVOT obviously decreased compared with pre-operative. 2 patients had MVR for MR in MVP groups. Conclusion The ideal method is extend septal myectomy, anomalous MV can be considered of MVR or MVP, and should firstly be choosed MVP if possible.