EFFECT OF SURGICAL RELIEF OF OBSTRUCTION IN HYPERTROPHIC CARDIOMYOPATHY

左心室梗阻的外科治疗 肌切开术或二尖瓣置换术是一种治疗选择 有严重症状的肥厚型心肌病患者 难以进行医疗管理。确定外科手术的效果 左室流出道梗阻的解除 对5例肥厚型心肌病患者在静息状态和运动中进行研究 手术前后心房起搏(间隔肌切除术者4例，二尖瓣切除者4例 瓣膜更换1例)。冠脉流向左心室前壁 间隔和游离壁是这些患者肥厚程度最高的部位， 通过热稀释进行评估。5例患者均获成功。 术前静息左室流出道压差的缓解 术后坡度由85正/负36毫米汞降至4正/负8毫米汞。 左心室流出道梗阻的外科解除 心室收缩压、冠脉流量和心肌氧含量 静息和起搏时的消耗量，降低了左心室 起搏后的舒张末压力，心绞痛阈值和 缺血的新陈代谢证据。这些结果证明了其重要性。 肥厚型心肌病左室流出道压差的研究。

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.