未闭合膜部室间隔缺损的外科处理

Surgical Management of Membranous Ventricular Septal Defect of Incomplete Spontaneous Closure

为了探明位于三尖瓣边缘上的小室间隔缺损（ＶＳＤ）术后易发生心内残余分流的原因，１９９１年１月至１９９２年６月，我们于术中观察了３０例这一类型的ＶＳＤ。发现有以下特点：（１）三尖瓣隔瓣及其腱索与室间隔粘连；（２）隔瓣下隐蔽着一个较大的膜部室间隔缺损（ＭＶＳＤ）；（３）隔瓣边缘上的１个或多个缺损间及与隔瓣下的ＭＶＳＤ相互交通。我们认为，隔瓣边缘上的小“ＶＳＤ”可能是ＭＶＳＤ未完全闭合的一种形式。采用切开隔瓣，修补ＭＶＳＤ，再缝合隔瓣切口的手术方法，成功地避免了术后心内残余分流。

Intracardiac residual shunts often occur after surgical repair of the apparently small ventricular septal defect (VSD) located at the margin of the septal leaflet of tricuspid valve.In order to define the causes of the residual shunt,pathological anatomy in 30 patients with this kind of small VSDs were observed from January,1991 through June 1992.The results showed that (1) the septal leaflet of tricuspid valve and its chordae tendinae adhered to the ventricular septum;(2) a major membranous ventricular septal defect(MVSD) was concealed under the septal leaflet;and (3) at the margin of septal leaflet,there was one or several holes communicating with each other and the underlying MVSD. The authors suggest that this kind of small VSDs could be a form of incomplete spontaneous closure of MVSD.Repair of the original MVSD through the incised septal leaflet is a good technic to ensure a complete closure and avoid postoperative residual shunt.