30例双腔右心室的外科治疗

Surgical treatment of 30 cases with double chambered right ventricle

目的 探讨过去10年我院双腔右心室的诊断及外科治疗经验.方法 回顾分析2006年1月至2016年7月我院接受外科治疗的30例双腔右心室的诊治情况.术前经超声心动图确诊27例,术中确诊3例.其中肌隔型18例,肌束型12例;单纯右室双腔心2例,合并室间隔缺损25例,房间隔缺损2例,动脉导管未闭2例,合并主动脉瓣下隔膜1例.手术切除右心室异常肥厚肌束,修补室间隔缺损,未予补片加宽右室流出道8例,用自体心包加涤纶补片加宽右室流出道22例,同时矫治心内其他畸形.结果 手术早期死亡1例,为成人双腔右心室合并三尖瓣中-重度关闭不全,术前有右心功能不全,出现腹胀及双下肢水肿等临床症状,术后出现低心排综合征,2d后死亡.其余患者手术效果满意,康复出院.死亡率为3.33％（1/30）,生存29例,无近期或中期死亡及相关并发症.术后29例随访,随访率100％,主要以门诊及电话随访.随访3个月至10年,本组2例术前三尖瓣轻度关闭不全,术后早期心脏彩超提示三尖瓣轻-中度关闭不全,考虑术中损失乳头肌所致,通过门诊心脏彩超随访,目前三尖瓣仍为轻-中度关闭不全,无右心功能不全表现.右室流出道疏通满意,目前暂无患者因右室流出道狭窄而再次手术.全组患者术后心功能明显改善,活动量明显增大,生长发育改善.结论 严格把握手术指征,术前充分评估,熟悉掌握病理解剖,有效疏通右室流出道并充分矫治心内其他畸形,手术治疗近、中期效果满意,远期待进一步随访.

Objective To explore the expericnce of diagnosis and surgical treatment for double chamber right ventricle during past ten years.Methods From January 2006 to July 2016,the 30 cases of patients with double chamber right ventricle who underwent surgical treatment were retrospective analyzed.27 cases were diagnosed preoperatively by echocardiography,and the others were diagnosed intraoperative.In which,type of muscular septum was of 18 cases,muscle bundle was of 12 cases.2 with of double cavity of right heart only,25 cases combinated with interventricular septal defect,2 cases with atrial septal defects,arterial catheter was not closed in 2 cases,aortic valve diaphragm under 1 case.The abnormal right ventricular hypertrophy muscle bundle was surgical removedand ventricular septal defect was reapaired.Not patch widen the right ventricular outflow tract in 8 cases,in 22 cases the right ventricular outflow tract was widen by using autologous pericardium and dacron patch,and the other deformities were corrected at the same time.Results 1 case with adult double chamber right ventricle combined with severe tricuspid valve incompetence died after surgery early,this case with right cardiac insufficiencyclinical symptoms such as bloating and double lower limbs swelling preoperation,and low cardiac syndrome happened postoperation,then died after 2 days.The rest of the patients were with satisfactory effect and rehabilitation.Mortality was 3.33％（1/30）.The postoperative follow-up was carried out mainly by the clinic and telephone,the rate was 100％ During the 3 months to 10 years follow-up,there were 2 cases with preoperative mild tricuspid valve insufficiency showedmild to medium tricuspid valve insufficiency which maybe related with the excision of papillary muscle.The surgery effects were satisfied in patients with narrowed right ventricular outflow tract.The right ventricular outflow tract is satisfactory,and no patient has been reoperated due to the narrowing of the right ventricle.The postoperative cardiac function was significantly improved in the whole group,and the activity increased significantly,and the growth and development were improved.Conclusion The surgical treatment for relieving of the narrow of right ventricle outflow tract and correcting the other malformation of the heartwas satisfactory in the near and mid-term effects,and further follow-up was expected.