EFFECT OF SURGICAL RELIEF OF OBSTRUCTION IN HYPERTROPHIC CARDIOMYOPATHY

左心室梗阻的外科治疗 肌切开术/肌切除术或二尖瓣置换术是治疗选择， 有严重症状的肥厚型心肌病患者， 药物治疗无效 为了确定手术的效果， 左室流出道梗阻的缓解 肥厚型心肌病，5例患者在休息和 术前、术后心房起搏（间隔肌切除术4例， 瓣膜置换术1例）。 左室前壁的冠状动脉血流 隔膜和游离壁，这些患者中最大肥大的部位， 通过热稀释法进行评估。 在所有5例患者中， 术前静息左心室流出道压差 术后压差为85 ± 36mmHg~4 ± 8mmHg。 左室流出道梗阻的外科治疗 心室收缩压、冠状动脉血流和心肌氧 静息时和起搏期间的消耗，左心室降低 起搏后舒张末期压，心绞痛阈值改善， 缺血的代谢证据 这些结果表明， 肥厚型心肌病患者左心室流出道压差的变化

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, 5 patients were studied at rest and during atrial pacing before and after operation (septal myectomy in 4 and mitral valve replacement in 1). Coronary flow to the anterior left ventricular septum and free wall, the site of maximum hypertrophy in these patients, was assessed by thermodilution. In all 5 patients there was successful relief of rest left ventricular outflow tract gradient from a preoperative gradient of 85\plus/minus\36mmHg to 4 plus/minus8mmHg postoperatively. Surgical relief of left ventricular outflow tract obstruction 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 angina threshold and metabolic evidence of ischemia. These results demonstrate the importance of left ventricular outflow tract gradients in hypertrophic cardiomyopathy.