PMC:3567831 / 10803-15018 JSONTXT

{"project":"testtesttest","denotations":[{"id":"T96","span":{"begin":235,"end":239},"obj":"Body_part"},{"id":"T97","span":{"begin":704,"end":708},"obj":"Body_part"},{"id":"T98","span":{"begin":889,"end":893},"obj":"Body_part"},{"id":"T99","span":{"begin":1177,"end":1181},"obj":"Body_part"},{"id":"T100","span":{"begin":1237,"end":1249},"obj":"Body_part"},{"id":"T101","span":{"begin":1315,"end":1327},"obj":"Body_part"},{"id":"T102","span":{"begin":1435,"end":1447},"obj":"Body_part"},{"id":"T103","span":{"begin":1701,"end":1713},"obj":"Body_part"},{"id":"T104","span":{"begin":1734,"end":1749},"obj":"Body_part"},{"id":"T105","span":{"begin":1847,"end":1851},"obj":"Body_part"},{"id":"T106","span":{"begin":2144,"end":2162},"obj":"Body_part"},{"id":"T107","span":{"begin":2226,"end":2245},"obj":"Body_part"},{"id":"T108","span":{"begin":3148,"end":3152},"obj":"Body_part"},{"id":"T109","span":{"begin":3334,"end":3338},"obj":"Body_part"},{"id":"T110","span":{"begin":3644,"end":3648},"obj":"Body_part"}],"attributes":[{"id":"A96","pred":"uberon_id","subj":"T96","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A97","pred":"uberon_id","subj":"T97","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A98","pred":"uberon_id","subj":"T98","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A99","pred":"uberon_id","subj":"T99","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A100","pred":"uberon_id","subj":"T100","obj":"http://purl.obolibrary.org/obo/UBERON_0002135"},{"id":"A101","pred":"uberon_id","subj":"T101","obj":"http://purl.obolibrary.org/obo/UBERON_0002135"},{"id":"A102","pred":"uberon_id","subj":"T102","obj":"http://purl.obolibrary.org/obo/UBERON_0002135"},{"id":"A103","pred":"uberon_id","subj":"T103","obj":"http://purl.obolibrary.org/obo/UBERON_0002137"},{"id":"A104","pred":"uberon_id","subj":"T104","obj":"http://purl.obolibrary.org/obo/UBERON_0002134"},{"id":"A105","pred":"uberon_id","subj":"T105","obj":"http://purl.obolibrary.org/obo/UBERON_0005953"},{"id":"A106","pred":"uberon_id","subj":"T106","obj":"http://purl.obolibrary.org/obo/UBERON_0005986"},{"id":"A107","pred":"uberon_id","subj":"T107","obj":"http://purl.obolibrary.org/obo/UBERON_0005987"},{"id":"A108","pred":"uberon_id","subj":"T108","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A109","pred":"uberon_id","subj":"T109","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"},{"id":"A110","pred":"uberon_id","subj":"T110","obj":"http://purl.obolibrary.org/obo/UBERON_0005956"}],"text":"RESULTS\nThe clinical data of the 93 consecutive obstructive HCM patients (57 men) with a mean age of 45.78 ± 13.39 (range 11–74) years who underwent TAESM in Fuwai hospital were collected and analysed. Preoperative TTE showed the peak LVOT gradient to be 91.76 ± 25.08 (13–171) mmHg at rest (all \u003e50 mmHg after physical provocation). The mean interventricular septal thickness was 25.39 ± 6.30 mm (15–46). SAM was identified in all (100%) and MR in 73 patients (73 of 93, 78.5%), of whom 41 were moderate level or more.\nAll the patients underwent TAESM in Fuwai Hospital, and all the surgical procedures of the 93 patients were technically successful. Initial intraoperative TEE showed a decrease in the LVOT gradient in all (pre- vs intraoperatively, 91.76 ± 25.08 vs 14.34 ± 13.44 mmHg, P \u003c 0.0005) and a significant improvement in MR (disappeared or mild). Six patients (6 of 93) had a LVOT gradient of 13–50 mmHg at rest and 74–124 mmHg after provocation, all of whom had drug-refractory symptoms after activity. They also underwent myectomy and all had a very good outcome. Further resection was carried out in two patients (2.2%) because intraoperative TEE showed a high LVOT gradient after the initial resection. Six patients had mitral valve replacement (MVR) because of obvious pathological changes of the mitral valve, such as damage by subacute bacterial endocarditis. Besides, another four cases underwent MVR after failed mitral valve plasty (MVP). Finally, SAM disappeared completely in 92 patients; only one (1.1%) still had mild SAM but without mitral-septal contact. Some concomitant surgical procedures were performed in 37 cases (37 of 93, 39.8%), including MVR in 10, MVP in nine, aortic valve replacement in six, tricuspid valve plasty in two, CABG in 18, Modified Maze procedure in three, cardiac tumour resection in two and RVOT reconstruction in one. Twelve patients had more than one concomitant procedure.\nThe average length of the postoperative stay was 7.8 ± 3.7 days. The 30-day and in-hospital mortalities were 0%. Complete atrioventricular block occurred in three cases (so permanent pacing was needed), complete left bundle branch block in 44, intraventricular conduction delay in 18, complete right bundle branch block (RBBB) in two, transient renal dysfunction in two (so hemodialysis was needed) and transient intra-aortic-balloon-pumping was needed in two. No other severe complications were observed during hospital stay.\nDuring a mean follow-up of 10.72 ± 11.02(1–24) months, there were no instances of lethal arrhythmia, myocardial infarction, stroke or death. Until the latest follow-up, all the patients had a significant reduction in limiting symptoms (e.g. shortness of breath) and a significant increase in physical capacity. The mean NYHA functional class decreased from 3.09 ± 0.60 (2–4) preoperatively to 1.12 ± 0.32 at the time of latest follow-up (P \u003c 0.0005). Eighty-two patients (NYHA class α, β or χ preoperatively) were free of limiting symptoms (NYHA class I) at the latest follow-up, and 11 (NYHA class β or χ preoperatively) had very mild limitations (NYHA class II). TTE identified that the LVOT turned to be widely patent throughout the cardiac cycle. Significant reductions to a mean level of 14.78 ± 14.01 mmHg were recorded by continuous-wave Doppler in peak instantaneous LVOT gradient. Mitral regurgitation remained absent (51) or at mild-(41)-to-moderate (1) levels. The main echocardiographic and NYHA data are shown in Table 2.\nTable 2: Parameters measured pre- and postoperatively, expressed as mean value (range) or number (%)\nParameter Preoperatively Postoperatively P-value\nLVOT peak gradient (mmHg) 91.76 ± 25.08 14.78 ± 14.01 \u003c0.0005\nMean MR level 1.35 ± 0.97 0.46 ± 0.52 \u003c0.0005\n None (0/4) 20 51\n Mild (1/4) 32 41\n Moderate (2/4) 30 1\n Moderately severe (3/4) 10 0\n Severe (4/4) 1 0\nSAM (n, %) 93 (100%) 1 (1.1%) \u003c0.0005\nNYHA class 3.09 ± 0.60 1.12 ± 0.32 \u003c0.0005\n I (1/4) 0 81\n II (2/4) 13 12\n III (3/4) 59 0\n IV (4/4) 21 0\nMean mitral regurgitation (MR) levels are scored as 0–4, to define no (0), mild (1), moderate (2), moderately severe (3) or severe regurgitation (4). NYHA class are scored as 1–4, to define classes I–V, respectively."}