METHOD FOR SURGICAL TREATMENT OF HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY IN PRESENCE OF CONTRAINDICATIONS TO USE OF ARTIFICIAL BLOOD CIRCULATION

摘要

FIELD: medicine; cardiosurgery. SUBSTANCE: proposed method resides in changing configuration of hypertrophic area of muscular part of heart's interventricular septum by dissecting latter (septotomy) in its upper third, i. e. corresponding to obstructed zone of blood discharge segment of heart's left ventricle. Dissection is practised from conical segment of right ventricle cavity on functioning heart by penetrating into depth of interventricular septum up to level 3-4 mm from endocardium of its left side, operation being conducted under control of intraoperative transesophageal echocardiography. Decrease in diastolic rigidity of myocardium and pressure gradient drop between discharge segment of left ventricle and aorta make it possible to effectively reduce load onto left ventricle in cardiomyopathy cases, thereby normalizing its functions and improving clinical condition of patients subjected to said operation to treat hypertrophic obstructive cardiomyopathy. Fact that operation is practised on functioning heart without resorting to use of artificial blood circulation apparatus under intraoperative transesophageal echocardiographic control permit to surgically treat extremely grave hypertrophic obstructive cardiomyopathy cases. EFFECT: considerably lower traumatism and damage to patient's heart's tissues; possibility to treat extremely grave cases.