室间隔基底部肥厚型和室间隔中部肥厚型梗阻性心肌病的临床特点及外科治疗对比

Clinical characteristics and surgical treatment comparison of hypertrophic obstructive cardiomyopathy: basal vs. mid-ventricular septal hypertrophy

摘要:

目的 评估室间隔基底部肥厚型和室间隔中部肥厚型梗阻性心肌病的临床特点及其在外科治疗方面的不同。方法 回顾性分析2019年3月—2021年3月首都医科大学附属北京安贞医院收治的83例梗阻性心肌病患者的临床资料，按梗阻部位分为室间隔基底部肥厚型组71例和室间隔中部肥厚型组12例。比较两组患者的年龄、性别、临床症状、手术方式、心脏超声检查结果及术后并发症等。结果 两组患者的年龄、性别构成、体质量指数、吸烟率、糖尿病患病率，心力衰竭发生率、NYHA心功能分级构成、二尖瓣反流程度构成、二尖瓣病理类型构成及处理方式构成比较，差异均无统计学意义（P >0.05）。两组患者术中主动脉阻断时间、术后房颤及手术死亡例数的比较，差异均无统计学意义（P >0.05）。室间隔基底部肥厚型组体外循环时间及住院时间均短于室间隔中部肥厚型组（P <0.05）。术前，室间隔基底部肥厚型组左室流出道压差、左室流出道流速、室间隔厚度、二尖瓣反流面积、左室舒末径、射血分数均高于室间隔中部肥厚型组（P <0.05），左室收末径低于室间隔中部肥厚型组（P <0.05）。术后1年，室间隔基底部肥厚型组射血分数高于室间隔中部肥厚型组（P <0.05），左室收末径低于室间隔中部肥厚型组（P <0.05）。术后随访结果显示，所有患者的临床症状均明显改善，心功能分级为Ⅰ、Ⅱ级，且无再次手术、远期并发症或死亡的情况发生。结论 室间隔基底部肥厚型和室间隔中部肥厚型梗阻性心肌病在临床表现和外科治疗方面存在差异，应根据患者的病理类型及临床表现选择合适的外科治疗方案，以达到更好的治疗效果。

Abstract:

Objective To evaluate the clinical characteristics of basal and mid-ventricular septal hypertrophy in hypertrophic obstructive cardiomyopathy (HOCM) and to compare their surgical treatment outcomes.Method A retrospective analysis of clinical data from 83 patients diagnosed with HOCM at Capital Medical University Affiliated Beijing Anzhen Hospital between March 2019 and March 2021 was conducted. Patients were divided into two groups based on the obstruction site: basal septal hypertrophy group (71 cases) and mid-ventricular septal hypertrophy group (12 cases). The age, sex, clinical symptoms, surgical methods, echocardiographic results, and postoperative complications were compared between the two groups.Result No statistically significant differences were found between the two groups regarding age, sex composition, body mass index, smoking rates, prevalence of diabetes, incidence of heart failure, NYHA functional classification, degree of mitral regurgitation, pathological types of mitral valve, and treatment methods (P > 0.05). The aortic occlusion time, postoperative atrial fibrillation, and surgical mortality were also comparable (P > 0.05). However, the extracorporeal circulation time and hospital stay in the basal hypertrophy group were shorter than those in the mid-ventricular hypertrophy group (P < 0.05). Preoperatively, the basal hypertrophy group had higher left ventricular outflow tract (LVOT) pressure gradients, LVOT flow velocities, septal thickness, mitral regurgitation areas, left ventricular end-diastolic diameters, and ejection fractions compared to the mid-ventricular hypertrophy group (P < 0.05), while the left ventricular end-systolic diameter was lower (P < 0.05). One year postoperatively, the ejection fraction in the basal hypertrophy group was higher than in the mid-ventricular hypertrophy group (P < 0.05), and the left ventricular end-systolic diameter was lower (P < 0.05). Follow-up results showed significant improvement in clinical symptoms for all patients, with heart function classifications of I and II, and no cases of reoperation, long-term complications, or mortality.Conclusion There are differences in clinical presentation and surgical treatment between basal and mid-ventricular septal hypertrophy in HOCM. Appropriate surgical treatment strategies should be selected based on the pathological types and clinical manifestations of patients to achieve better therapeutic outcomes.