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はじめに 閉塞性肥大型心筋症(HOCM)に対する心筋切除の基本術式は,Morrowらによる経大動脈弁アプローチであるが1),心室中部閉塞性心筋症(MVO)や心尖部肥大型心筋症(apical HCM)に対しては,十分な中隔心筋切除ができない可能性がある.われわれは,経僧帽弁的に中隔心筋切除と自己心膜パッチによる僧帽弁前尖拡大を行い,経過良好であった症例を報告する.
A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) combined with organic mitral regurgitation underwent transmitral septal myectomy and mitral valve plasty. Although a transaortic septal myectomy (Morrow’s procedure) is generally accepted as the standard surgical treatment for HOCM, it may be difficult to perform sufficient septal myectomy for mid-ventricular obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy (HCM). The transmitral approach with temporary detachment of the anterior mitral leaflet provides a good surgical view in the left ventricle, which allows sufficient septal myectomy from the outflow tract to the apex.
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