| Objective: Ventricular septal myectomy has been considered as the gold standard for the treatment of refractory left ventricular outflow tract(LVOT)obstruction in patients with hypertrophic obstructive cardiomyopathy(HOCM).The purpose of this study is to provide the surgical experience of isolated septal myectomy in our hospital,to comment on the safety and efficacy of this operation,and to provide clinical basis for the choice of surgical methods for HOCM patients.Clinical data and methods: We retrospectively analyzed 58 patients with HOCM without inherent abnormalities of the mitral valve device treated by isolated septal myectomy in our hospital from June 2009 to June 2019.There were 35 males(60.3%)and 23 females(39.7%).The age was 28 to 73 years old,the average age was(53.15±12.41)years old,the weight 38-78 kg,and the average weight was(63.67±7.33)kg.The main symptoms were before operation: chest tightness and shortness of breath in 53 cases(91.4%),chest pain in 22 cases(37.9%),palpitations in 17 cases(29.3%),syncope in 8 cases(13.7%).Preoperative NYHA grade I was found in 1 case(1.7%),grade II 7 cases(12.1%),grade III 46 cases(79.3%),grade IV 4 cases(6.9%);45(81.0%)Patients had SAM sign before surgery,and 53 patients had mitral regurgitation(including 18 patients with mild regurgitation,30 patients with moderate regurgitation,and 5 patients with moderate-severe regurgitation).The changes of maximum pressure gradient of left ventricular outflow tract,left atrial diameter,thickness of interventricular septum,left ventricular ejection fraction,E’ value,E/ E’value,mitral regurgitation degree and SAM sign were evaluated by color Doppler in all patients in 1 week after operation,and 6 months after operation.Results: One patient died of cardiogenic shock due to low cardiac output during hospitalization.22 patients underwent classic ventricular septal myectomy and 36 patients underwent modified extended Morrow surgery.The average time of cardiopulmonary bypass was(98.86±23.32)min,the average time of aortic clamping was(43.28±16.82)min,the average operation time was(211.54±30.76)min,the average time of tracheal intubation was(23.04±8.83)h,The average time in Intensive Care Unit was(2.44±0.81)d,and the average postoperative hospital stay was(14.70±4.24)d.The main postoperative complications included 6 cases of left bundle branch block,1 case of complete atrioventricular block,10 cases of atrial fibrillation,2cases of residual obstruction,3 cases of pleural effusion and 1 case of iatrogenic ventricular septal defect((VSD)).At rest,the pressure gradient of the left ventricular outflow tract decreased from(104.84±15.26)mm Hg preoperatively to(18.70±5.93)mm Hg 1 week after surgery(p <0.001),at 6 months postoperatively,it was(17.14±5.12)mm Hg(p <0.001).and the thickness of the interventricular septum decreased from(21.34±2.14)mm preoperatively to(14.95±1.51)mm 1 week after surgery(p <0.001),at 6 months postoperatively,it was(14.91±1.22)mm(p <0.001),and the internal diameter of left atrium decreased from(44.97±4.41)mm preoperatively to(41.15±4.53)mm 1 week after surgery(p <0.05),at 6 months postoperatively,it was(39.14±3.21)mm(p<0.001);E’ changed from(4.32±1.56)preoperatively to(6.32±1.87)1 week after surgery(p<0.001),at 6 months postoperatively,it was(6.56±1.67)(P<0.001);E / E’ changed from(20.26±3.90)preoperatively to(14.07±3.61)1 week after surgery(p<0.001),at 6 months postoperatively,it was(13.99±3.25)(p<0.001).LVEF was within the normal range.The patient’s symptoms and heart function have been improved to varying degrees.During the follow-up,the mitral valve mostly closed well or only mild regurgitation,SAM sign disappeared or mild SAM sign.The patients were divided into two groups according to the presence or absence of SAM before operation.One group had no SAM sign before operation,and the other group had SAM sign before operation.it was concluded that there were significant improvements in left ventricular outflow tract pressure gradient,left atrial size,interventricular septum thickness,E’ value and E/E’ value between the two groups,and there was no significant difference in the surgical effect between the two groups.Conclusion: isolated ventricular septal myectomy can significantly reduce the LVOT pressure gradient and eliminate mitral regurgitation caused by SAM,improve the hemodynamics and diastolic function of patients in the early and middle stages,and it is a safe and effective operation;In the case of internal mitral valve pathology,Patients with mitral regurgitation caused by SAM do not need to undergo mitral valve surgery at the same time. |
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