Septal anterior ventricular exclusion procedure for idiopathic dilated cardiomyopathy.
Septal anterior ventricular exclusion procedure for idiopathic dilated cardiomyopathy.
复制标题
室间隔前室排除术治疗特发性扩张型心肌病。
DOI：
10.1016/j.athoracsur.2006.04.096
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发表时间：
2006
影响因子：
4.6
通讯作者：
F. Nomura
中科院分区：
文献类型：
--
作者：
H. Suma;T. Isomura;T. Horii;F. Nomura
总结了8年来对原发性扩张型心肌病所致充血性心力衰竭患者施行间隔前室隔离术的经验。（27名男性和9名女性，平均年龄60岁）患有心力衰竭;纽约心脏协会III/IV级（21/15）;二尖瓣返流2+或更大，当舒张期尺寸为75 mm或更大，并且间隔无动力时，手术适用。缝合一个长而窄的椭圆形补片，通过排除间隔和前壁形成缩小的椭圆形左心室。所有患者均行二尖瓣重建术（26例使用尺寸过小的瓣膜环进行修复，10例使用生物瓣膜进行置换），16例患者（44%）增加了三尖瓣修复术。院内死亡率为13.8%（5/36），其中择期手术死亡率为6.5%（2/31），急诊手术死亡率为60%（3/5）。射血分数从20.9% ± 6.4%增加到27.5% ± 8.8%，左室舒张末期内径从81.9 ± 9.2 mm减小到70.1 ± 10.0 mm，左室舒张末期和收缩末期容积指数分别由236.5 ± 65.0 mL/m2和181.3 ± 55.4 mL/m2降至183 ± 60.5 mL/m2和181.3 ± 55.4 mL/m2。m2降至133.5 ± 54.1mL/m2。左室舒张末期压从24.3 ± 9.7 mm Hg降至19.4 ± 7.6 mm Hg。术后1至6个月，脑钠肽从975 ± 866 pg/mL降至404 ± 366 pg/mL。观察到11例晚期死亡，原因为心力衰竭（6）、猝死（4）和卒中（1）。存活者的平均纽约心脏协会分级为1.7。1年和3年生存率分别为67.5%和60.7%，respectively. CONCLUSIONSSThe室间隔前室隔离术与二尖瓣重建术是治疗晚期特发性扩张型心肌病的一个有用的选择，在极度扩张的左心室与无动力间隔。
BACKGROUNDEight-year experience with the septal anterior ventricular exclusion procedure for congestive heart failure due to idiopathic dilated cardiomyopathy was evaluated.METHODSIn 36 patients (27 men and 9 women with a mean age of 60 years) with heart failure; New York Heart Association class III/IV (21/15); and mitral regurgitation 2+ or greater, the procedure was indicated when the diastolic dimension was 75 mm or greater, and the septum was akinetic. A long, narrow oval patch was sutured to form a downsized elliptical left ventricle by excluding the septum and anterior wall. Mitral reconstruction was combined for all patients (26 repairs with undersized ring and 10 replacements with bioprosthesis) and tricuspid repair was added for 16 patients (44%).RESULTSHospital mortality was 13.8% (5 of 36), with 6.5% (2 of 31) in elective and 60% (3 of 5) in emergency operations. Ejection fraction increased from 20.9% ± 6.4% to 27.5% ± 8.8%, left ventricular diastolic dimension decreased from 81.9 ± 9.2 mm to 70.1 ± 10.0 mm, and left ventricular endodiastolic and endosystolic volume indices decreased from 236.5 ± 65.0 mL/m2to 183 ± 60.5 mL/m2and from 181.3 ± 55.4 mL/m2to 133.5 ± 54.1 mL/m2, respectively. Left ventricular endodiastolic pressure decreased from 24.3 ± 9.7 mm Hg to 19.4 ± 7.6 mm Hg. Brain natriuretic peptide decreased from 975 ± 866 pg/mL to 404 ± 366 pg/mL at 1 to 6 postoperative months. Eleven late deaths were noted and were due to heart failure (6), sudden death (4) and stroke (1). The mean New York Heart Association class was 1.7 among the survivors. One- and 3-year survival rates were 67.5% and 60.7%, respectively.CONCLUSIONSThe septal anterior ventricular exclusion procedure with mitral reconstruction is a useful option for the treatment of advanced idiopathic dilated cardiomyopathy in extremely dilated left ventricle with akinetic septum.