Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy

MA Hong-yan; ZHANG Qin-bin; ZHOU Hong

doi:10.3969/j.issn.1672-5301.2017.04.016

Abstract：Objective To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy (HOCM).Methods From January 2010 to October 2013,72 HOCM patients underwent surgical treatment in our hospital.There were 36 males and 36 females ranging from 13-70 (46.51-±13.45)years old.Operation was performed under general anesthesia and cardiopulmonary bypass(CPB) with the moderate systemic temperature and low volume blood flow.The concomitant operations included coronary artery bypass grafting in 4 cases,mitral valve replacement in 8 cases,mitral valve plasty in 2 cases,aortic valve replacement in 2 cases,aortic valve plasty in 1 case,closure of patent ductus arteriosus in 1 case,right ventricular outflow dredging operation in 1 case,left atrial thrombus removal in 1 case,left atrial appendage ligation in 2 cases,maze procedure in 4 cases,intraoperative pacemaker implantation in 2 cases.Preoperative and postoperative left ventricular end diastolic diameter,left ventricular outflow tract(LVOT),interventricular septal thickness,LVEF,mitral valve function and value were evaluated by Ultrasonic echocardiography and transesophageal echocardiograph examination (TEE).Results Comparing with the pre-operative echocardiographic parameters,the pressure of left ventricular outflow tract [(9.42±7.48)mm Hg vs (79.76±51.9)mm Hg,P＜0.01],and the thickness of septum [(1.87-±0.57)cm vs (2.36-±0.48)cm,P＜0.01] significantly decreased.Long-term follow-up of left ventricular outflow tract pressure decreased further(7.57±5.21) mm Hg,the thickness of septum thinner further (1.69-±0.45)cm.Left ventricular end diastolic diameter at the time of discharge has been expanded,and has further expanded at long-term follow-up.EF decreased (P＜0.01),but still in the normal range.There was no one dead.The main complications:complete left bundle branch block in 52 cases,right bundle branch block in 2 cases,intraventricular block in 3 cases,atrial fibrillation in 7 cases(including 3 cases of paroxysmal atrial fibrillation),transient Ⅱ-Ⅲ degree A-V block in 5 cases,continuous A-V block in 2 cases,ventricular septal perforation in 1 case,cerebral hemorrhage in 2 cases,acute cholecystitis in 1 case.Long term follow-up:5 cases were lost to follow-up,the remaining 67 cases were followed up for 3-53 months(average 18 months),the symptoms disappeared in all patients,improved quality of life,heart function Ⅰ-Ⅱ,no long-term death or complications.Conclusion Surgical outcome for HOCM patients is satisfactory.Most HOCM patients achieve such a satisfactory relief of LV outflow tract obstruction as to lead a better life.