出版社：Japan Society of Circulation Control in Medicine
摘要：This report reviews current knowledge concerning the pathophysiology, hemodynamics, and perioperative management of hypertrophic cardiomyopathy (HCM). HCM is a primary myocardial disease that causes ventricular hypertrophy. This condition occurs in at least 1 per 200 individuals in the general population, and many patients with HCM have a family history of HCM inherited in an autosomal dominant pattern. HCM can cause atrial fibrillation, heart failure, and sudden death with ventricular fibrillation. The incidence of perioperative complications increases in correlation with moderate or severe mitral regurgitation, significant left ventricular outflow tract (LVOT) pressure gradient, heart failure with reduced ejection fraction (EF), and heart failure with preserved EF. Patients with HCM should be handled in a manner similar to that used in case of patients with aortic stenosis. The management of hemodynamic status ranges from minimally invasive monitoring for mild cases to monitoring using transesophageal echocardiography (TEE) for severe cases. TEE is useful for patients with HCM as it can evaluate morphometric images and systolic and diastolic function. The severity of HCM and LVOT obstruction is correlated with the incidence of cardiovascular complications. Perioperative management should also be based on the pathophysiological knowledge of HCM.
