室间隔缺损合并三尖瓣囊袋的手术治疗

Surgical treatment of ventricular septal defect with tricuspid valve pouch

目的 室间隔缺损（ Ｖ Ｓ Ｄ） 合并三尖瓣囊袋的病理改变与普通 Ｖ Ｓ Ｄ 不同，三尖瓣囊袋与膜部间隔瘤亦有区别，为 Ｖ Ｓ Ｄ 合并三尖瓣囊袋的患者进行手应予以注意。方法 经手术治疗４２ 例病人，男１８ 例，女２４ 例，年龄４ ～２３（ 平均８ ．５） 岁。在低温体外循环下进行手术，瓣认室间隔缺损跟三尖瓣的关系，观察三尖瓣的病理改变，并切开三尖瓣暴露真正的 Ｖ Ｓ Ｄ。５ 例病人以带垫片双头针钱间断褥式缝合 Ｖ Ｓ Ｄ，３７ 例病人采用补片修补法。结果 ４２ 例病人，１ 例遗留室间隔缺损残余漏，其余病例杂音完全消失，手术效果满意。结论 三尖瓣囊袋与膜部膨出瘤在病理上完全不同。 Ｖ Ｓ Ｄ 合并三尖瓣囊袋的手术治疗与一般 Ｖ Ｓ Ｄ 手术方法不同，应予以注意，否则可能遗留 Ｖ Ｓ Ｄ 修补术后残余漏。

Objective Tricuspid Valve pouch should not be confused with aneurysms of the membranous ventricular septum. The operation method for repair of the perimembranous ventricular septal defect(VSD) with tricuspid valve pouch should be discussed.Methods 42 patient with VSD with tricuspid valve pouch were treated by surgical operation.Ages at operation raged from 4 to 22 years(median 8.5 years).There were 18 males and 24 females.The right atrium was opened with the use of total cardiopulmonary bypass.Ventricular septal defect was exposed through tricuspid anulus and the tricuspid pouch was incised to expose the actual VSD.In 5 cases,The VSD was repaired with double-armed sutures with pledgets by mattress suture technique.Synthetic patch was used in 37 patients.Results There were no deaths in all patients.One patient had a residual shunt and a heart murmur.The results were excullent in the others.Conclusions The pathology of the tricuspid pouch is different from that of the membranous ventricular septum.It is important that tricuspid valve should be incised to expose the actual VSD for closure of the VSD with tricuspid pouch.