| Objective:To provide a basis and reference for the choice of treating hypertrophic obstructive cardiomyopathy through surgery by comparing the effect of classical Morrow procedure and modified Morrow procedure on left ventricular outflow tract unblocking and the effect of whether mitral valvuloplasty or mitral valve replacement was performed at the same time on the improvement of mitral valve influencing factors in hypertrophic obstructive cardiomyopathy,and analyzing the follow-up results.Data and methods:This study is based on the treatment on a total of 54 patients with hypertrophic obstructive cardiomyopathy between January 01,2014 and December 31,2019.The patients,aged 51.5±15.5 years and weighing 67.22±12.3 kg,were treated either by classical Morrow procedure or modified Morrow procedure in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Zhengzhou University.Out of the 54 patients,there were 27 male(50.0%)aged 45.4±16.6 years with weight of 72.5±13.7 kg and 27 female(50.0%)aged 57.7±11.9 years with weight 61.9±7.9 kg.52(96.3%)patients had SAM.52(96.3%)patients had various degrees of mitral valve insufficiency on ultrasound,where 22 of them were mild,16 moderate and 14 severe mitral valve insufficiency,including 13 cases of organic lesions,6 cases of mitral valve prolapse,6 cases of rheumatic mitral valve insufficiency,and 1 case of infective endocarditis.The patients’pre-operation NYHA classifications were 3(5.6%)in classⅡ,41(75.9%)in class Ⅲ and 10(18.5%)in class Ⅳ.30(55.6%)of the patients were treated by classic Morrow,where 8 of them were MVR and 3 were MVP.24(44.4%)of the patients were treated by modified Morrow,where 8 of them were MVR and 8 MVP.The data were analyzed and a comparison is made based on the mean values of different samples performed by t-test,and the categorical variables such as chi-square test or Fisher’s exact probability method.Results:One of the patients with classical Morrow+MVR had sudden cardiac arrest on the second postoperative day,and after resuscitation,the patient’s family gave up the treatment.Another two patients with modified Morrow+MVR had severe postoperative hypovolemic syndrome,after adjuvant therapy such as ECMO was given,the basic vital signs were difficult to maintain.After consulting the patients’family,they decided to terminate the treatment.For the remaining 51 patients,echocardiogram was repeated 1 week after surgery,and the results indicated that the LVOT pressure difference was significantly lower than that before surgery,and the LVOT pressure difference was 19.317±14.5707 mmHg for the group treated by the classical method and 12.0000±5.5032 mmHg for those by the modified method,where P=0.018(P<0.05)is statistically significant;the 29 patients treated with the classical method had a reduction of LVOT pressure of 77.855±35.4442mmHg and the 22 with modified method had a reduction of 105.909±48.6561mmHg,where P=0.028(P<0.05)is also statistically significant.One of the patients in the classical group and one in the modified group had LVOT pressure reduction of 12.000±5.5032mmHg,where P=0.018(P<0.05)is statistically significant.One of the patients in the classic group and one in the modified group still had residual SAM signs after surgery while the remaining patients had no SAM signs.20 of the patients had mild mitral valve insufficiency,while the remaining patients had no mitral valve abnormalities.3 months after the surgery,the LVOT pressure difference was 17.07±114.285 mmHg in the classical group and 11.18±4.239 mmHg in the modified group,where P=0.043(P<0.05)showing that the difference was statistically significant;the reduction of LVOT pressure difference was 80.10±35.637mmHg in the 29 patients who underwent classical Morrow.35.637mmHg in 29 patients who underwent classical Morrow and 106.73±49.095mmHg in 22 patients who underwent modified Morrow,where P=0.038(P<0.05)was statistically significant.There were 20 cases of mild mitral valve insufficiency and none of the rest.6 months after the surgery,the LVOT pressure difference became 19.21 ±14.965mmHg in the classical group and 12.09±5.291mmHg in the modified group,where P=0.023(P<0.05)is statistically significant;the reduction in LVOT pressure difference was 77.97±35.914mmHg in the 29 patients who underwent classical Morrow.The difference between the two groups was statistically significant.One patient in the classical group and one in the modified group still had a residual SAM sign,while the rest had a negative SAM sign.23 patients had mild mitral valve.There were 23 cases of mild mitral valve insufficiency,and the rest of the patients had no mitral regurgitation.The difference between group A and group B was statistically significant,with P<0.001.When comparing the pre-operation and 1-week post-operation mitral valve status of group A patients,the P value was greater than 0.05,and the difference was not statistically significant.When comparing the mitral valve conditions in group A before surgery with those in 3 months and 6 months after surgery,the P values were less than 0.05,and the difference was statistically significant.Conclusions:By analyzing and comparing the results of echocardiography after 1 week,3 months and 6 months of operation,it is clear that both classical Morrow procedure and modified Morrow procedure are effective treatments for hypertrophic obstructive cardiomyopathy,and both can significantly reduce the LVOT pressure difference in HOCM patients.The effect of modified Morrow procedure on reducing the LVOT pressure step difference is more obvious than that of classical Morrow.In terms of improvement of pre-operation SAM phenomenon and mitral valve insufficiency,both the classic Morrow procedure and the modified Morrow procedure were very effective.In patients with combined organic mitral valve lesions such as mitral valve prolapse,rheumatic mitral valve insufficiency,and infective endocarditis,mitral valve replacement or mitral valvuloplasty should be performed at the same time for further management of the mitral valve to improve the occurrence of mitral valve insufficiency and SAM.If the degree of mitral valve insuficiency is moderate or lower,mitral valve replacement or mitral valvuloplasty is not required during septal myocardial resection,and mitral valve insufficiency can be improved compared with the preoperative condition.If the degree of mitral valve insufficiency is moderate or higher,mitral valve replacement or mitral valvuloplasty is required during left ventricular outflow tract evacuation.If the degree of mitral valve insufficiency is moderate or above,mitral valve replacement or mitral valvuloplasty should be performed at the same time as LV outflow tract dilation to improve mitral valve insufficiency and SAM significantly. |
PDF Full Text Request