人工隔瓣在房室共同通道矫治术中的应用

The use of prosthetic septal leaflet in the surgical treatment of atrioventricular septal defect

目的 报告在房室共同通道矫治术中应用人工隔瓣的方法与结果。方法 1991年 8月至1997年 12月 ,对 16例部分型与 6例完全型房室共同通道伴隔瓣缺如者进行矫治手术。其中 3例按以往术式进行 (对照组 ) ,19例利用修补原发孔型房间隔缺损的涤纶片终端作成“人工隔瓣” ,同时修补瓣裂、DeVega成形和修复房、室间隔缺损。结果 19例应用人工隔瓣者术后无死亡及传导阻滞发生 ,全部恢复良好 ;仅 2例三尖瓣有轻度反流。对照组死亡 1例 ;2例生存者 ,术后三尖瓣均有中度反流 ,右心功能欠佳 ,恢复缓慢。结论 延长修补房间隔缺损的涤纶片作成人工隔瓣 ,附加 2条人工腱索防止“脱垂” ,比较符合实际三尖瓣的解剖结构 。

Objective To introduce a method of presenting prosthetic septal leaflet in the surgical treatment of atrioventricular septal defect with absent septal leaflet. Method From August 1991 to December 1997, 22 patients with atrioventricular septal defect (16 partial, 6 complete) with absent septal leaflet underwent surgical correction. In 3 patients surgical procedures performed included closure of atrial and ventricular septal defect, commissuroplasty and annuloplasty. In another 19 patients the dacron patch used to repair ostium primum was extended to creat a “prosthetic septal leaflet”. Results There was no operative mortality and AV block in the patients with prosthetic septal leaflet. The heart function was significantly improved and only two patients had slight tricuspid regurgitation. In 3 patients treated conventionally there was one operative death, 2 survivors had moderate tricuspid insufficiency and right heart failure. Conclusion The dacron patch used to repair the atrial septal defect could be extended as a prosthetic septal leaflet and two prosthetic chordae tendinca are added to prevent 'inversion'. Anatomical structure of tricuspid valve is reconstructed and tricuspid regurgitation will be reduced significantly.