改良扩大Morrow手术治疗儿童肥厚型梗阻性心肌病的临床研究 .pdfVIP

改良扩大Morrow手术治疗儿童肥厚型梗阻性心肌病的临床

研究

张旌;徐海涛;陈亮;王水云;宋云虎;王强;李守军;闫军

【摘要】目的:分析改良扩大Morrow手术(室间隔心肌切除术)治疗儿童肥厚型梗

阻性心肌病(HOCM)的近期和远期疗效.方法:回顾性分析中国医学科学院阜外医院

对2010-01至2017-07实施改良扩大Morrow手术的50例HOCM患儿(年龄

≤14岁)住院结局、围术期以及远期超声心动图(UCG)变化.结果:47例患儿术后症

状明显改善或消失,1例术后因停机困难行体外膜肺氧合(ECMO)辅助120h脱机后

出院,2例术后死于肺部感染;3例发生三度房室阻滞.与术前相比,患儿室间隔厚度

(IVST)显著减小[(14.3±6.7)mmvs(21.2±9.7)mm,P0.001],左心室流出道压力阶

差(LVOTG)明显降低[(19.6±17.3)mmHgvs(74.8±25.0)mmHg,P0.01,1

mmHg=0.133kPa].仅4例(8.5%)术后仍存在二尖瓣前向运动(SAM).45例存活

患儿平均随访(27.7±14.0)月,纽约心脏协会(NYHA)心功能分级均为Ⅰ级或Ⅱ

级,UCG示LVOTG[(15.5±12.5)mmHgvs(74.8±25.0)mmHg]和

IVST[(14.3±7.9)mmvs(21.2±9.7)mm]仍较低(P均0.01).结论:改良扩大

Morrow手术可明显改善HOCM患儿的症状及心功能,远期结果满

意.%Objectives:ModifiedextendedMorrowprocedurefortreatmentof

childrenwithhypertrophicobstructivecardiomyopathy(HOCM)isa

complicatedandchallengingprocedure.Ourstudysoughttoassessthe

effectandoutcomeofmodifiedextendedMorrowprocedureinchildren

withHOCM.Methods:FromJanuary2010toJuly2017,50consecutive

pediatric(age≤14years)patientswithHOCMunderwenttransaortic

modifiedextendedMorrowprocedureinFuwaiHospital.Clinicaldataof

thesepatientswereanalyzedretrospectively.Pre-operativeandpost-

operativeechocardiographydatawereanalyzed,includingleftatrialsize,

leftventricularenddiastolicdiameter,leftventricularejectionfraction,left

ventricularoutflowtractpeakpressure,ventricularseptalthickness,mitral

systolicanteriormotionandgradeofmitralregurgitation.Results:Mean

ageatthetimeofoperationwas(84.4±57.7)month(6month-14year).

Meanbodyweightatthetimeofsurgerywas(28.4±20.7)kg(4.3-92.0)kg.

Therewere2deathsaftertheoperation.Threepatientshadpostoperative

completeheartblockandreceivedpermanentpacemakerimplantation.

Aftermyectomy,leftventricularoutflowtr