改良三尖瓣前瓣转移成形术在部分型心内膜垫缺损矫治术中的应用

Application Value of Modified Tricuspid Valvuloplasty Using Anterior Leaflet in Surgery of Partial Antrioventricular Septal Defect

目的探讨改良三尖瓣前瓣转移成形术在部分型心内膜垫缺损合并三尖瓣隔瓣发育不良矫治术中的应用,评价其治疗效果。方法选取2002年6月至2014年3月于我院行外科手术治疗的部分型心内膜垫缺损合并三尖瓣隔瓣发育不良患者95例,男39例、女56例,年龄3个月~46(3.2±6.6)岁。术前超声心动图提示所有患者均有不同程度的三尖瓣隔瓣发育不良及三尖瓣关闭不全,轻度14例,中度49例,重度32例。根据三尖瓣前瓣、隔瓣的发育情况,采取不同的方法矫治合并的三尖瓣病变:隔瓣残余瓣叶大于正常瓣叶1/3者,将前瓣的隔瓣侧缘一半与隔瓣的左2/3连续缝合;隔瓣残余瓣叶小于正常瓣叶1/3者,在缝合房间隔缺损心包补片时预留室间隔嵴右侧部分心包片,将其左侧缘2/3与前瓣的隔瓣侧近瓣根部一半连续缝合。所有患者术中使用食管超声评价瓣膜成形效果,出院后3~6个月随访复查超声心动图,评价三尖瓣的闭合情况。结果全组围术期无死亡病例,无Ⅲ度房室传导阻滞。术中食管超声提示三尖瓣成形效果满意,90例无明显反流,3例轻度反流,2例中度反流。术中主动脉阻断时间(35.2±11.2)min,体外循环时间(64.9±16.6)min。术后3~6个月随访,三尖瓣成形术后反流情况均较术前显著改善,其中89例为轻度以下反流,6例为中度反流,无重度反流患者。结论应用前瓣行三尖瓣成形可有效治疗部分型心内膜垫缺损患者的三尖瓣关闭不全,治疗效果满意。

Objective To investigate the therapeutic effect of modified tricuspid valvuloplasty using anterior leaflet in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.Methods Ninety-five patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia underwent surgical treatment in our hospital from June 2002 to March 2014.There were 39 males and 56 females with an average age of 3.2±6.6 years(range 3 months to 46 years).Preoperative echocardiography prompted all patients had varying degrees of tricuspid valve dysplasia and tricuspid regurgitation(mild in 14 cases,moderate in 49 cases,and severe in 32 cases).According to the different development of anterior and septal leaflet,we used different techniques to repair the tricuspid problems.If the residual septal leaflet was larger than one third of the normal septal leaflet,we continuously stitched the half of the septal side of anterior leaflet to the two third of the left side of residual septal leaflet.If the residual septal leaflet was less than one third of the normal septal leaflet,we reserved part of pericardial patch at right side of septal crest at repairing the atrial septal defect,and continuously stitched the left two third of the patch edge to the half of septal side of anterior leaflet.All patients received transesophageal echocardiography(TEE) to evaluate the intraoperative effect of valvuloplasty.The patients were followed up with echocardiography after 3 to 6 months to evaluate the condition of tricuspid.Results There was no perioperative death or Ⅲ degree atrioventricular block.Intraoperative TEE showed that the effect of tricuspid valvuloplasty was good with 3 cases of mild regurgitation and 2 cases of moderate regurgitation.Other 90 cases had no significant regurgitation.The aortic cross-clamping time was 35.2±11.2 min and cardiopulmonary bypass time was 64.9±16.6 min.In the followed-up between 3 to 6 months,tricuspid regurgitation situation improved significantly than that in preoperative period with mild regurgitation or no reflux in 89 cases and moderate regurgitation in 6 cases.There was no severe regurgitation occurred.Conclusion The therapeutic effect is satisfactory by using anterior leaflet to repair the regurgitation of tricuspid in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.