Ventricular Myocardiectomy

Myocardial resection is a treatment for ventricular septal hypertrophy. Postoperative symptoms disappear or significantly reduce, systolic pressure difference disappears, and aortic pressure waveform returns to normal. Echocardiography and selective left ventricular angiography revealed an increase in left ventricular lumen, and anterior mitral valvular anterior leaflet disappeared, but atrial fibrillation remained. About 90% of patients have improved postoperative cardiac function to grade 1-2. Treatment of diseases: hypertrophic cardiomyopathy, hypertrophic obstructive cardiomyopathy Indication Hypertrophic cardiomyopathy, obstructive cardiomyopathy. Surgical procedure (1) Aortic and left ventricular combined incision myocardial resection: The sternal median incision is treated with extracorporeal circulation combined with hypothermia. A decompression drainage tube is placed in the left atrium to block the ascending aorta. The cold cardiac arrest fluid is injected into the root and the myocardial temperature is locally lowered. The ascending aortic root is transversely cut. The right coronary artery was pulled forward with a hook, and the U-shaped myocardium was removed from the ventricular septum with a round knife. The incision began from the lower right coronary valve and extended to the left to the lower left and left coronary valve junctions. Do not extend the ventricular septal incision to the right to avoid damage to the left atrioventricular bundle leading to complete conduction block. The ventricular septal rectangular myocardial piece is elongated downward under direct vision, but it cannot be cut too deeply. In the lower part of the anterior wall of the left ventricle, a oblique incision about 4 cm parallel to the lowest oblique angle branch is made, and the left ventricular cavity below the anterior papillary muscle is inserted, and the anterior valve leaflet is pulled to the left side of the ventricular septum through the incision, and is used from the bottom to the left. The scalpel resected the ventricular septal hypertrophic myocardium, and connected with the aortic resected myocardial piece, and then cut off the whole hypertrophic myocardium. The depth of the incision was about 15-20 mm to trim the myocardial fragments to prevent embolism. Intermittently suture the whole layer of the myocardial incision and suture the aortic incision The left ventricular cavity and aortic residual gas are discharged, the aortic occlusion forceps are removed and the body temperature is raised, and the cardiopulmonary bypass is stopped after the heart beat is strong. (B) through the aortic incision ventricular septal myocardial resection and incision: Establish extracorporeal circulation and take myocardial protection measures to block the aortic blood flow through the transverse incision of the ascending aorta root, pull the right coronary valve to reveal the ventricular septum, and use a small round knife to make two parallel incisions in the upper part of the ventricular septum below the right coronary valve. The lower part of the open room compartment can compress the free wall of the right ventricle, move the ventricular septum to the left ventricular cavity to improve the exposure, and then remove the rectangular hypertrophic myocardial tissue between the two parallel incisions. Press the ventricular septal incision with your fingers, increase the depth and width of the ventricular septal sulcus, remove the myocardial fragments, suture the aortic incision, expel the gas in the left ventricular cavity and the aorta, and remove the aortic occlusion forceps. Rewarming to a body temperature of 35 ° C or more, after the heart beats vigorously, stop the extracorporeal circulation, if the myocardial resection of the ventricular septal hypertrophy is still not satisfactory, can be completely removed by the left ventricular incision. complication About 5% of cases were complicated by complete conduction block, and the incidence of left or right bundle branch block was higher. In addition, a small number of patients with perioperative myocardial infarction, ventricular septal perforation, left ventricular ventricular aneurysm and iatrogenic aortic valve or mitral regurgitation.

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