改良扩大Morrow手术治疗青少年肥厚型梗阻性心肌病患者的早期疗效分析

摘要

Objective: To evaluate the efifcacy of modiifed extended Morrow procedure on hypertrophic obstructive cardiomyopathy (HOCM) in adolescent patients. Methods: We retrospectively studied 29 consecutive HOCM patients at the age≤21 years who received modiifed extended Morrow procedure in our hospital from 2011 to 2015 for their clinical conditions to assess surgical efifcacy. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outlfow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Moreover, pre-operative and post-operative plasma NT-proBNP levels were determined. Cardiac function was evaluated by New York Heart Association functional class. Results: There were 17 (58.6%) patients received isolated modiifed extended Morrow procedure and 12 patients had concomitant operation including 8 (27.6%) with coronary artery bypass grafting. Compared with pre-operation, the post-operative thickness of ventricular septum decreased from (24.6 ± 6.8) mm to (16.9 ± 7.1) mm, left ventricular outlfow tract gradient decreased from (68.8 ± 15.7) mmHg to (10.7 ± 4.2) mmHg, bothP<0.001; mitral regurgitation degree reduced from (1.7 ± 1.3) to (0.2 ± 0.4),P<0.01; NYHA classification improved from (3.4 ± 0.8) to (1.4 ± 0.5),P<0.01; plasma level of NT-proBNP reduced from (1957.6 ± 392.5) ng/ml to (458.7 ± 161.0) ng/ml,P<0.01. There was no peri-operative death, the survival rates at 12, 24 and 36 months post-operation were 100%, 86.7% and 86.7% respectively. Conclusion: Modiifed extended Morrow procedure has been a safe and effective method for treating adolescent HOCM patients, adequate exposure is the key point to assure surgical efifcacy.%目的：评价改良扩大Morrow手术（室间隔心肌切除术）治疗青少年肥厚型梗阻性心肌病（HOCM）的早期手术疗效。方法：回顾性分析我院2011年至2015年改良扩大Morrow手术治疗29例青少年（≤21岁）HOCM患者的临床资料，评价早期手术疗效。术前、术后超声心动图检查比较左心房前后径、左心室舒张末期内径、左心室射血分数、室间隔厚度、左心室流出道峰值压差、二尖瓣收缩期前向运动征和二尖瓣反流分级变化，同时抽血检测术前、术后血浆N末端B型利钠肽原水平变化，采用纽约心脏协会心功能分级评估心功能。结果：本组患者中，接受单纯改良扩大Morrow手术者17例（58.6%），同时行冠状动脉旁路移植术者8例（27.6%）。与术前比较，改良扩大Morrow手术后患者的室间隔厚度显著减小[（24.6±6.8）mm vs （16.9±7.1）mm，P<0.01]，左心室流出道峰值压差明显降低[（68.8±15.7）mmHg（1 mmHg=0.133 kPa） vs （10.7±4.2）mmHg，P<0.01]，二尖瓣反流明显减轻[（1.7±1.3）级 vs （0.2±0.4）级，P<0.01]，纽约心脏协会心功能分级显著改善[（3.4±0.8）级 vs （1.4±0.5）级，P<0.01]，血浆N末端B型利钠肽原水平显著下降[（1957.6±392.5）ng/ml vs （458.7±161.0）ng/ml，P<0.01]。无围手术期死亡。术后第12、24、36个月患者的生存率分别为100.0%、86.7%和86.7%。结论：改良扩大Morrow手术是治疗青少年HOCM安全、有效的手段，术中充分暴露是保证手术效果的重要措施。