CAJ | 학술논문

目的探讨室间隔心肌切除术治疗药物难治性肥厚梗阻型心肌病,分析其远期效果及影响预后的危险因素.方法 1996至2009年,连续外科手术治疗86例药物难治性肥厚梗阻型心肌病患者.男51例,年龄6～67岁,平均(37±16)岁,术前左心室流出道收缩压差(LVOTPG)为61～150mm Hg(1 mm Hg =0.133 kPa),平均(98±27) mm Hg.手术均采用经升主动脉切口的室间隔心肌切除术.围术期采用经胸及经食管超声心动图和心导管检查评价心脏结构和功能.术后随访0.75～ 12.5年,平均(4.8±3.3)年.结果术后院内死亡4例,另外有2例分别于手术后4个月及1年时于院外发生猝死.随访74例患者,术后3个月时生存70例(94.6％),1年时69例(93.2％),5年时68例(91.9％).随访中有63例术后症状缓解,56例患者静息状态下LVOTPG小于30 mm Hg.63例患者术后心功能NYHA分级Ⅱ～Ⅱ级,其中Ⅱ级的比例大于65％.结论外科治疗肥厚梗阻型心肌病具有较好的远期生存率,可明确地解除患者的临床症状,提高生活质量.手术中彻底疏通左室流出道,避免完全房室传导阻滞及其它并发症是手术成功及术后恢复的关键.
목적 탐토실간격심기절제술치료약물난치성비후경조형심기병,분석기원기효과급영향예후적위험인소.방법 1996지2009년,련속외과수술치료86례약물난치성비후경조형심기병환자.남51례,년령6～67세,평균(37±16)세,술전좌심실류출도수축압차(LVOTPG)위61～150mm Hg(1 mm Hg =0.133 kPa),평균(98±27) mm Hg.수술균채용경승주동맥절구적실간격심기절제술.위술기채용경흉급경식관초성심동도화심도관검사평개심장결구화공능.술후수방0.75～ 12.5년,평균(4.8±3.3)년.결과 술후원내사망4례,령외유2례분별우수술후4개월급1년시우원외발생졸사.수방74례환자,술후3개월시생존70례(94.6％),1년시69례(93.2％),5년시68례(91.9％).수방중유63례술후증상완해,56례환자정식상태하LVOTPG소우30 mm Hg.63례환자술후심공능NYHA분급Ⅱ～Ⅱ급,기중Ⅱ급적비례대우65％.결론 외과치료비후경조형심기병구유교호적원기생존솔,가명학지해제환자적림상증상,제고생활질량.수술중철저소통좌실류출도,피면완전방실전도조체급기타병발증시수술성공급술후회복적관건.
Objective To evaluate clinical and echocardiography long-term results of septal myectomy surgery in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods We examined retrospectively 86 consecutive patients [age(37 ± 16)years] with HOCM operated on in our institution from 1996 to 2009.With a left ventricular outflow tract gradient of(98 ±27) mmHg by Doppler echocardiography.54 patients (63％) were in New York Heart Association (NYHA) functional class Ⅲ-Ⅳ.54 patients (63％) underwent isolated septal myectomy and others combined with additional procedures.The surgical technique used in all patients was septal myectomy performed through an aortomy.Mean follow-up was(4.8 ±3.3) years.Results The perioperative mortality rate was 4.7％ (n =4).The cumulative survival rate at 3 month,1 year,and 5 years was 94.7％,93.4％,and 92.1％ respectively,and late symptom-free rate was 85％.The left ventricular outflow tract gradient was nearly eliminated in most patients,85 ％ of the patient has a Ⅰ-Ⅱ NYHA functional class.Conclusion Surgical septal myectomy can be performed safely,with excellent survival,improvement from symptoms and relief for LVOT obstruction in patients with HOCM.The early benefits were remained at long term.