EFFECT OF SURGICAL RELIEF OF OBSTRUCTION IN HYPERTROPHIC CARDIOMYOPATHY

手术缓解肥厚型心肌病梗阻的效果

• 批准号: 3942929
• 负责人: R O CANNON
• 金额: --
• 依托单位: NATIONAL HEART, LUNG, AND BLOOD INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3942929
• 关键词: electronic pacemaker; heart circulation; heart disorder diagnosis; heart output disorder; heart valve transplantation; human subject; hypertrophic myocardiopathy; intracardiac pressure; mitral valve; mitral valve stenosis; myocardial ischemia /hypoxia; oxygen consumption; thermal blood flow measurement

Surgical relief of left ventricular obstruction by left ventricular myotomy/myectomy or mitral valve replacement is a therapeutic option in patients with hypertrophic cardiomyopathy who are severely symptomatic and refractory to medical management. To determine the effects of surgical relief of left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy, 20 patients were studied at rest and during atrial pacing before and after operation (septal myectomy in 14 and mitral valve replacement in 6). Coronary flow to the anterior left ventricle and septum, the site of maximum hypertrophy in these patients, was assessed by thermodilution. In all 20 patients there was successful relief of resting left ventricular outflow tract gradient from a preoperative gradient of 61+35 to 4+7 mmHg postoperatively. Surgical relief of left ventricular outflow tract obstruction significantly reduced left ventricular systolic pressure, coronary flow, and myocardial oxygen consumption at rest and during pacing, lowered left ventricular end-diastolic pressure following pacing, and improved anginal threshold and metabolic evidence of ischemia. These results demonstrate the importance of left ventricular outflow tract gradients in hypertrophic cardiomyopathy as well as the mechanism of improved effort tolerance after surgical relief of obstruction.

手术解除左心室梗阻 肌切开术/肌切除术或二尖瓣置换术是 肥厚型心肌病患者的治疗选择 症状严重且难以接受医疗治疗的人 管理。 确定手术缓解左侧疼痛的效果 肥厚型患者的心室流出道梗阻 心肌病，20 名患者在休息和运动期间进行了研究 手术前后心房起搏（14例室间隔肌切除术） 和 6) 中的二尖瓣置换术。 冠状动脉血流 左心室前部和室间隔，最大的部位 通过热稀释法评估这些患者的肥厚情况。 所有 20 名患者的左侧休息症状均得到成功缓解 心室流出道梯度与术前梯度的比较 术后 61+35 至 4+7 mmHg。 左侧手术缓解 左心室流出道梗阻明显减轻 心室收缩压、冠状动脉血流和心肌 休息时和起搏时的耗氧量，向左降低 起搏后心室舒张末压得到改善 心绞痛阈值和缺血的代谢证据。 这些 结果证明左心室流出的重要性 肥厚型心肌病的束梯度以及 手术缓解后努力耐受力改善的机制 梗阻。