先天性三尖瓣发育不全的外科治疗

Surgical Management of Congenital Dysplasia of the Tricuspid Valve

目的：报告１１例先天性三尖瓣发育不全外科治疗病例。方法：中度低温体外循环下经右房行三尖瓣成形术８例中ＤｅＶｅｇａ６例、Ｋａｙ２例，三尖瓣替换术３例中高位替换２例、原位替换１例。结果：１１例病人均痊愈出院。结论：术式的选择要依据瓣膜发育情况，特别是前瓣和瓣下结构行成形术时需做瓣膜补片扩大，裂孔修补；对ＩＩ度发育不良者需切除瓣膜及瓣下结构，以疏通流出道，同时行瓣膜替换术；对隔瓣薄并与心肌融合者可行右房侧三尖瓣替换术。

Aim:To review the experience of surgical treatment of congenital dysplasia of the tricuspid valve.Clinical material and method:From 1983 to 1997,11 patients with dysplasia of the tricuspid valve were treated surgically in our hopsital.There were 5 males and 6 females with a mean age of 20 years(range,6 to 46 years).Echocardiography revealed right ventricular and right atrial enlargement in 11,severe tricuspid regurgitation in 5 and moderate in 6.ECG showed right atrial hypertrophy in 11 and atrial fibrillation in 4.3 patients were associated with atrial septal defect.The operations were carried out under the cardiopulmonary bypass(CPB).8 patients underwent tricuspid annuloplasty(DeVega's procedure in 6 and Kay's operation in 2).3 patients received tricuspid valve replacement .Result:There were no operative deaths and severe postoperative complications.All patients recovered smoothly. During the mean follow up of 4 years(range,10 months to 7 years),2 patients developed arrhythmia and 2 patients had mild tricuspid regurgitation .One late death occurred 6 months after surgery because of non cardiac reason.Conclusion:Surgery can be performed for dysplasia of the tricuspid valve with a low mortality and low morbidity.Selection of surgical procedures depends on nature and severity of the tricuspid valve lesions.