肥厚型梗阻性心肌病患者二尖瓣叶长度及对合形态异常的超声心动图随访研究

目的:应用超声心动图评估肥厚型梗阻性心肌病(HOCM)患者二尖瓣叶长度及对合形态的特点,以及单纯行扩大室间隔切除术后二尖瓣叶对合形态的改变。方法:入组2012年至2017年间中国医学科学院阜外医院由同一个有经验术者行扩大室间隔切除术(术中未特殊处理二尖瓣叶)的HOCM患者52例为HOCM组,同时纳入性别和年龄相匹配的健康受试者23例为正常对照组。比较两组二尖瓣参数以及左心房、室指标的差异,且随访观察HOCM组患者在扩大室间隔切除术前、术后二尖瓣参数和左心房、室指标的变化以及是否出现新发的、有血流动力学意义的二尖瓣反流。平均随访(7.10±7.57)个月。结果:与正常对照组比较,HOCM组患者二尖瓣瓣环前后径(Ann D)、二尖瓣前叶长度(ALL)、后叶长度(PLL)、前乳头肌根部直径(APM)和反乳头肌根部直径(PPM)均增大(P均<0.01),前叶在瓣环上的投影长度(Pro L)及其占瓣环总长度的比例(Pro R)均减小(P均<0.01),左心房前后径(LAD)增大,室间隔基底段厚度(IVS)明显增加,左心室舒张末期内径(LVEDD)减小(P<0.01),瓣叶对合高度(Ten H)无差异(P>0.01),瓣叶对合点到前室间隔的最近距离(C-sept)及乳头肌连线平面与前室间隔的距离(S-P)均明显减小(P<0.01)。与术前比较,HOCM组患者在扩大室间隔切除术后,二尖瓣反流明显减少(P<0.01),二尖瓣反流均在轻度以下,未见新发的有血流动力学意义的反流;Ann D、Pro L、Pro R、Ten H与术前比较均无明显差异(P均>0.01),C-sept及S-P较术前均明显增大(P均<0.01);LAD、IVS、左心室后壁厚度(LVPWD)、左心室射血分数(LVEF)较术前均明显减小,LVEDD较术前增大(P均<0.01)。结论:HOCM患者经过充分的室间隔切除,二尖瓣反流均能得到明显改善。虽然二尖瓣前后叶均延长,但术后中期随访结果未见新发的、有血流动力学意义的二尖瓣反流。HOCM患者二尖瓣对合形态异常、对合点前移,手术解除梗阻后,异常的对合形态未见恢复。

Changes on the Prolonged Leaflets and Abnormal Tenting Morphology of Mitral Valve in Patients With Hypertrophic Obstructive Cardiomyopathy Post Septal Myectomy

Objectives:To evaluate the leaflet length and tenting morphology of mitral valve at baseline and post myectomy in patients with HOCM by echocardiography.Methods:52 patients with HOCM,who underwent septal myectomy from 2012 to 2017 at Fuwai hospital by an experienced surgeon,were involved in this analysis.The parameters of mitral valve were compared between HCOM and normal control subjects,and among HOCM patients at baseline and post operation(follow up time 1-36 months,mean7.10±7.57]months)by echocardiography.Results:Ann D,ALL,PLL,APM,PPM were significantly increased,while both Pro L and Pro R were significantly decreased(all P<0.01 vs normal control group).Compared with the normal control group,larger LAD,thickened IVS,and decreased LVEDD were found in HOCM group(all P<0.01).Ten H was similar between HOCM and normal control groups(all P>0.01).C-sept and S-P decreased significantly in HOCM group(both P<0.01).After septal myectomy,Mitral insufficiency significantly decreased(P<0.01).Ann D,Pro L,Pro R,Ten H remained unchanged compared with pre-operative measurements(all P>0.01).C-sept,S-P and LVEDD were significantly increased and LAD,IVS,LVPWD,LVEF were significantly decreased post myeectomy as compared to pre-operative values(all P<0.01).Conclusions:Mitral insufficiency can be relieved through adequate myectomy in patients with HOCM.Despite prolonged leaflets of mitral valve,there is no recurrent,significant mitral regurgitation during post-operative follow-up.HOCM patients have abnormal tenting morphology of mitral valve,which is not affected by septal myectomy.