三尖瓣置换治疗Ebstein心脏畸形

Tricuspid valve replacement for Ebstein's anomaly

确定Ebstein畸形病人瓣膜置换术的手术适应证。方法 31例 5～ 4 6岁病人 ,其中10例曾接受过修复术 ,全部手术均在全麻体外循环下完成 ,4例心脏不停跳。分别置换生物瓣 2枚 ,国产人工机械瓣膜 13枚和进口人工机械瓣 16枚 ;同时对其他合并畸形进行修复。结果 体外循环转流时间 56～ 136min ,2 7例主动脉阻断时间 2 9～ 83min。 12例病人手术结束时直视下测压 ,右心房压 15 8 7 5mmHg( 1mmHg =0 133kPa) ,右心室压 2 6 3 5 3mmHg ,肺动脉压 2 1 8 13 5mmHg ;死亡 2例。结论 Ebstein畸形病人三尖瓣环明显扩大 ,三尖瓣隔瓣发育不良或缺如 ,而且下移过多 ,前瓣瓣叶或瓣下结构与右心室融合 ,影响前瓣的活动 ;或者前瓣虽然发育尚好 ,但过大的瓣叶已脱至右室流出道 ,影响血流动力学者 。

Objective: To determine the surgical indications of tricuspid valve replacement for Ebstein's anomaly. Methods: Tricuspid valve replacement was performed in 31 patients. The age ranged 5 to 46 years. 10 cases previously tricuspid valve repair. The operation was carried out under general anesthesia and extracorporeal circulation including 4 patients on beating heart. The valve implanted included 2 biovalves, 13 China-made and 16 imported mechanical prosthesis valves. Others cardiac malformations were simutaneouly corrected. Results: The total time of aortic cross clamping was 29 to 83 minutes. CPB time was from 56 to 136 minutes. Cardiac pressure was measured in 12 patients at the end of operations. The right atrial pressure was 20.4/10.2 mmHg, right ventricle pressure was 26.3/5.3 mmHg and pulmonary artery pressure was 21.8/13.5 mmHg. There were 2 operative deaths. Conclusion: Tricuspid valves replacement should be considered in those patients with markedly enlarged tricuspid ring. The underdevelopment of septal leaflet downward displacement of anterior leaflet, and its attachment adhering to right ventricular wall or displaced into the right ventricle outflow tract.