SURGICAL TREATMENT OF IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS - TECHNIC AND HEMODYNAMIC RESULTS OF SUBAORTIC VENTRICULOMYOTOMY
SURGICAL TREATMENT OF IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS - TECHNIC AND HEMODYNAMIC RESULTS OF SUBAORTIC VENTRICULOMYOTOMY
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DOI：
10.1097/00000658-196108000-00003
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发表时间：
1961-01-01
影响因子：
9
通讯作者：
BROCKENBROUGH, EC
中科院分区：
文献类型：
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作者：
MORROW, AG;BROCKENBROUGH, EC
在大多数左心室流出道梗阻的患者中，解剖学上的病变是主动脉瓣狭窄、离散的纤维性瓣下膜或更罕见的瓣膜上方升主动脉狭窄。然而，最近来自该诊所和其他诊所的报告已经引起了对另一种迄今未被认识的阻塞形式的关注，这种阻塞形式称为特发性肥厚性主动脉瓣下狭窄。在这种畸形中，左心室心肌肥厚，特别是在室间隔区。在心室收缩期，心室流出道变窄，以致左心室射血出现阻力，心室内出现收缩压梯度。在国家心脏研究所，15名患者被诊断为肥大性主动脉瓣下狭窄，并在其他地方详细描述了他们的临床、血流动力学和血管造影结果。*尽管在几个接受手术的患者中意外地遇到了这种病变，这种病变被认为是主动脉瓣狭窄的常见形式之一，但人们普遍认为切除肥大肌肉是不可行的，因此这种主动脉瓣下狭窄不适合手术治疗。
IN TE MAJORITY of patients with obstruc-tion to left ventricular outflow the respon-sible anatomic lesion is found to be stenosis of the aortic valve, a discrete fibrous subvalvular membrane or, more rarely, a constriction in the ascending aorta immediately above the valve. Recent reports from this and other clinics, however, have called at-tention to another and hitherto unrecognized form of obstruction termed idiopathic hypertrophic subaortic stenosis.***** In this malformation there is massive hypertrophy of the left ventricular myocardium, particularly in the area of the interventric-ular septum. During ventricular systole the outflow tract of the ventricle narrows to such an extent that resistance to left ven-tricular ejection occurs and a systolic pres-sure gradient develops within the ventricle. At the National Heart Institute the diagno-sis of hypertrophic subaortic stenosis has been established in 15 patients and a de-tailed description of the clinical, hemodynamic and angiographic findings in them has been presented elsewhere.* Although the lesion has been encountered unexpect-edly in several patients undergoing opera-tions for what was considered to be one of the usual forms of aortic stenosis, it has been generally considered that resec-tion of the hypertrophic muscle is not feasi-ble and that this form of subaortic stenosis is, therefore, not amenable to surgical treatment.