Surgical Treatment And Clinical Efficacy For Children With Hypertrophic Obstructive Cardiomyopathy

[Abstract]Objective:Surgical therapy for children with HOCM is complicated in technology and high in risk, related reports at home and abroad remains scant at present. This paper retrospectively analyses the clinical Efficacy and the follow-up results of children with HOCM who underwent ventricular septal myectomy.Methods:From October 2007 to January 2015,38 children with HOCM underwent ventricular septal myectomy in Fuwai Hospital, of which 27 cases were male (71.1%). Mean age at diagnosis was 7.3+/-4.6yrs (range,1day to 13.5yrs). Mean age at operation was 11.3+/-4.3yrs (range,0.7 to 16.7yrs). Mean weight at operation was 41.3+/-20. lkg(range,4.3 to 92.0). Preoperative resting left ventricular outflow tract gradient (LVOTG) was 81.2+/-34. OmmHg. Ventricular septal myectomy through the incision of ascending aortic root had been performed in all patients, all of which received postoperative follow-up to observe clinical efficacy. Results:all patients underwent ventricular septal myectomy, concomitant procedures included right ventricular septal resection (n=3), mitral valve repair (n=3),coronary artery bypass grafting(n=4), closure of atrial septal defect (n=4),subaortic membrane resection (n=1) and lysis of myocardial bridge(n=1).1 infants received adjuvant ECMO postoperatively, but there was no perioperative death, surgical outcomes were excellent. Postoperative resting left ventricular outflow tract gradient (LVOTG), interventricular septal thickness, degree of mitral regurgitation and left ventricular ejection fraction were significantly decreased(P<0.001) compared with the preoperative. Residual SAM and LVOT obstruction were reported in 2 patients(5.3%) and 3 patients (7.9%) respectively, while moderate aortic regurgitation was found in 2 patients (5.3%).30 patients received telephone follow-up. Restrictive symptoms were improved in all these patients with NYHA functional class Ⅰ or Ⅱ.A 15.8-year-old patient died suddenly 16 months after the operation. A permanent pacemaker was installed in 1 patient(3.3%)3 months after operation for complete heart block. Conclusion:Ventricular septal myectomy can relieve LVOT obstruction safely and effectively, by which the clinical symptoms, the quality of life and the long-term prognosis can be improved. For patients with major risk factors for SCD, prophylactic ICD placement is necessary for the purpose of reducing long-term rates of SCD.