用改良的三尖瓣置换术治疗三尖瓣下移畸形的效果分析

Effect of Modified tricuspid valve replacement for Ebstein anomaly

目的 :分析用改良的三尖瓣置换术治疗三尖瓣下移畸形的临床效果。方法 :对2010年7月至2016年12月期间在延边大学附属医院心外科接受治疗的10例三尖瓣下移畸形患者的临床资料进行回顾性分析。在这10例患者入院后,均采用改良的三尖瓣置换术对其进行治疗。其中,有4例使用机械瓣的患者,有6例使用生物瓣的患者。治疗结束后,观察这10例患者手术的情况、临床治疗的效果、术后并发症的发生情况及远期的疗效。结果 :这10例患者在术中、术后均未发生死亡及三度房室传导阻滞,其体外循环转机的时间平均为(95.26±36.88)min,其主动脉阻断的时间平均为(67.35±31.08)min。在手术结束后,这10例患者中有1例患者接受二次开胸止血,有2例患者发生低心排综合征,有1例患者发生肺部感染,这4例患者经治疗后均痊愈出院。在这10例患者中,有9例患者的心功能恢复至Ⅱ级,有1例患者的心功能恢复至Ⅲ级。在这10例患者出院后,均对其进行了为期6个月~5年的随访,除1例患者在随访1年后失联外,其余的9例患者均生存良好,也未出现房室传导阻滞、瓣周漏及与抗凝相关的并发症。结论 :用改良的三尖瓣置换术对三尖瓣下移畸形患者进行治疗的效果确切,可有效地避免其发生三度房室传导阻滞,最大限度地保留其右心室的功能,从而获得良好的远期疗效。

Objective To analyzes clinical effect of Modified tricuspid valve replacement for Ebstein anomaly. Methods 10 cases with Ebstein anomaly were operated from July 2010 to December 2016 and clinical data were analyzed retrospectively. All patients accepted modified tricuspid valve replacement, mechanical valve were used on 4 patients, bioprosthetic valve were used on 6 patients.After treatment, to observe operative situation, effective rate, incidence of complications and ong-term effect. Results The 10 cases of patients are all alive and didn't occurred third degree a-v block,average aortic crossclamp time is(67.35±31.08)min. After operation, there is 1 case of patients accepted Re-thoratomy for hemaostsis,2 cases of patients occurred low cardiac output syndrome,1 case of patient occurred pulmonary infection, and the 4 cases were discharge after treatment. Among the 10 cases, there are 9 cases of patients' cardiac function were recovered to level II, 1 case of patient's cardiac function were recovered to level III. We followed-up the 10 cases of patients in 6 months to 5 years, except 1 case of patient lost after 1 year, other 9 cases of patients were alive fine, and didn't occurred atrioventricular block, perivalvular leakage,and implications on anticoagulation.Conclusion Effect of Modified tricuspid valve replacement for Ebstein anomaly is significant, it will avoiding third degree a-v block effectively, for maximum function of right ventricle protection and achieve good long-term effect.