LI Xiaoyi 1 , WU Hongxiang 1 , WANG Ruobing 1 , LIU Haozhong 1 , ZENG Xiaodong 1 , ZENG Ying 1,3 , WANG Shengwen 1 , HUANG Minjie 1 , YUAN Haiyun 1,2 , LIU Jian 1,2 , GUO Huiming 1,2
  • 1. Department of Cardiology, Guangdong Institute of Cardiovascular Disease, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, 510080, P. R. China;
  • 2. Guangdong Provincial Key Laboratory of Structural Heart in South China, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, 510080, P. R. China;
  • 3. School of Medicine, South China University of Technology, 510641, P. R. China;
GUO Huiming, Email: guohuiming@gdph.org.cn
Hypertrophic cardiomyopathy; children; interventricular septal myectomy; pacemaker
10.7507/1007-4848.202309013
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Objective  To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods  The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, hospitalization outcomes, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results  A total of 29 patients were collected, including 22 males and 6 females, aged (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal myectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, the left atrial diameter decreased (36.58±6.00 mm vs. 28.83±3.97 mm, P<0.05). Left ventricular end-systolic diameter increased (17.19±5.47 mm vs. 20.82±7.40 mm, P<0.05], and peak pressure gradient of left ventricular outflow tract decreased (87.13±31.38 mm Hg vs. 17.52±16.15 mm Hg, P<0.01). The thickness of ventricular septum decreased (23.13±8.45 mm vs. 18.22±5.92 mm, P<0.05). The systolic anterior motion of mitral valve disappeared and mitral regurgitation was reduced (5.14±3.56 cm2 vs. 1.28±1.18 cm2, P<0.01). The flow velocity and peak pressure gradient of right ventricular outflow tract were also reduced in the patients who underwent right ventricular septal myocardial resection. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (87.13±31.38 mm Hg vs. 19.26±17.80 mm Hg, P<0.01). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal myocardial resection. Conclusion  Right ventriclar or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve cardiac function in these patients. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.