三尖瓣下移畸形外科治疗42例(1)
[摘要] 目的 总结42例三尖瓣下移畸形的外科治疗及其疗效。 方法 2003年1月～2010年12月我院对42例三尖瓣下移畸形患者施行了手术矫治，其中行三尖瓣成形术34例(包括6例加双腔腔肺分流术)，三尖瓣置换术8例；矫治合并畸形：房间隔缺损或卵圆孔未闭30例，室间隔缺损4例。 结果 全组无死亡病例，无Ⅱ～Ⅲ度房室传导阻滞。术后B超复查提示34例成形术患者有6例存在轻-中度返流。1例患者2年后因三尖瓣重度返流行换瓣术。术后患者心功能均恢复至Ⅰ～Ⅱ级。 结论 应根据三尖瓣病变情况选用最佳的矫治方法，并同期矫治合并心内畸形。
[关键词] 三尖瓣；畸形；外科治疗；瓣膜成形；瓣膜置换
[中图分类号] R654.2 [文献标识码] B [文章编号] 1673-7210(2012)02(a)-0156-02
Surgical treatment on 42 cases of ebstein malformation
, http://www.100md.com
YU Guanshui ZHONG Zhimin HU Lian LIU Chao ZHOU Qifu
Deparment of Cardiac Surgery, the People's Hospital of Gaozhou City Affiliate to Guangdong Medical School, Guangdong Province, Gaozhou 525200, China
[Abstract] Objective To summarize the surgical treatment and results on 42 cases of ebstein malformation. Methods 42 cases of ebstein malformation underwent surgical were corrected from January 2003 to December 2010 in our hospital. Tricuspid valvuloplasty were performed in 34 cases (including 6 cases of dual-chamber cavopulmonary shunt plus), tricuspid valve replacement were performed in 8 cases; malformations were corrected: atrial septal defect or patent foramen ovale were 30 cases, ventricular septal defect were 4 cases. Results There were no deaths and no Ⅱ-Ⅲ degree atrioventricular block. Post-operative review of B-mode ultrasound examination prompted that 6 cases presented with mild-moderate regurgitation in 34 cases of angioplasty patients. 1 case was underwent valve replacement surgery due to severe tricuspid regurgitation after two years. Cardiac function restored to Ⅰ-Ⅱ level after surgery. Conclusion It should chose the best treatment methods according to the tricuspid valve disease, while do the treatment with heart malformations.
, 百拇医药
[Key words] Tricuspid valve; Deformity; Surgical treatment; Valvuloplasty; Valve replacement
三尖瓣下移畸形(ebstein malformation)是一种临床上少见的复杂性心脏畸形，其主要的治疗方法为手术治疗。我科从2003年1月～2010年12月共对42例三尖瓣下移畸形患者行手术治疗，其中三尖瓣成形术34例(包括6例加双腔腔肺分流术)，三尖瓣置换术8例；矫治合并畸形中房间隔缺损或卵圆孔未闭30例，室间隔缺损4例，临床效果良好，现总结报道如下：
1 资料与方法
1.1 一般资料
本组34例三尖瓣成形术患者中，男26例，女16例；年龄2～46岁，平均(21.8±7.2)岁；体重8～76 kg，平均(46.5±10.3)kg；术前血红蛋白含量102～251 g/L，平均(140.8±25.1)g/L；红细胞压积33%～68%，平均(41.3±9.8)%；术前有明显的活动性呼吸困难10例，活动后心悸4例，有发绀及杵状指7例；胸骨左缘和(或)剑突下可闻及收缩期杂音。心电图检查提示完全性右束支传导阻滞或不完全性右束支传导阻滞10例。超声心动图提示三尖瓣均有中-重度返流；测量三尖瓣隔瓣下移12～54 mm，平均(30.0±8.2)mm；后瓣下移10～50 mm，平均(24.0±5.2)mm；前瓣下移平均(7.0±5.2)mm，有1例下移51 mm。合并房间隔缺损30例，室间隔缺损4例。心功能(YAHA分级)为Ⅱ级20例，Ⅲ级8例，Ⅳ级6例。
, 百拇医药
1.2 手术方法
手术均在全麻、中低温体外循环下进行。取胸骨正中切口，全身给予肝素化(3.5 mg/kg)后，行升主动脉插管和上、下腔静脉插管，建立体外循环通道，右上肺静脉放置左心引流管加压。阻断钳阻断升主动脉，4℃冷血高钾停跳液顺灌灌停心脏，心脏表面置冰泥，主动脉阻断期间每30分钟灌注半量心肌保护液。在右心房作平行房室沟的切口，拉开心脏探查三尖瓣前、后、隔各瓣及其瓣下结构的发育情况，探查右心室大小及其房化的程度，左心室发育状况及其他合并心内畸形情况，以便决定手术方式。体外循环时间为56～260 min，平均(94.0±38.1)min；阻断主动脉30～93 min，平均(70.0±10.2)min。
共行三尖瓣成形术34例，其中用水平房化右室折叠三尖瓣成形术法横行折叠房化右室22例，加Devega或Kay法成形8例；用垂直房化心室折叠三尖瓣成形术法纵行折叠房化右室12例，加Devega或Kay法成形4例；另外取用自体心包片加宽隔瓣2例，应用Gore-Tex人工腱索2例，应用Carpentier人工瓣环6例。行三尖瓣成形术加双腔腔肺分流术6例；均于心复跳后，上腔静脉与右肺动脉端侧吻合。三尖瓣置换术8例，采用CarboMedics双叶机械瓣31号2例，29号2例；采用Medtronic生物瓣31号4例。全组均用带垫涤纶线行间断褥式缝合，完整切除病变的三尖瓣及瓣下结构组织等，缝合时将Koch三角均保留在右心房。矫治合并畸形：房间隔缺损30例，室间隔缺损4例，均于同期行直接修补术。全组术后均安装心外膜临时起搏导线备用。, 百拇医药(余观水 钟志敏 胡楝 刘超 周启付)
[关键词] 三尖瓣；畸形；外科治疗；瓣膜成形；瓣膜置换
[中图分类号] R654.2 [文献标识码] B [文章编号] 1673-7210(2012)02(a)-0156-02
Surgical treatment on 42 cases of ebstein malformation
, http://www.100md.com
YU Guanshui ZHONG Zhimin HU Lian LIU Chao ZHOU Qifu
Deparment of Cardiac Surgery, the People's Hospital of Gaozhou City Affiliate to Guangdong Medical School, Guangdong Province, Gaozhou 525200, China
[Abstract] Objective To summarize the surgical treatment and results on 42 cases of ebstein malformation. Methods 42 cases of ebstein malformation underwent surgical were corrected from January 2003 to December 2010 in our hospital. Tricuspid valvuloplasty were performed in 34 cases (including 6 cases of dual-chamber cavopulmonary shunt plus), tricuspid valve replacement were performed in 8 cases; malformations were corrected: atrial septal defect or patent foramen ovale were 30 cases, ventricular septal defect were 4 cases. Results There were no deaths and no Ⅱ-Ⅲ degree atrioventricular block. Post-operative review of B-mode ultrasound examination prompted that 6 cases presented with mild-moderate regurgitation in 34 cases of angioplasty patients. 1 case was underwent valve replacement surgery due to severe tricuspid regurgitation after two years. Cardiac function restored to Ⅰ-Ⅱ level after surgery. Conclusion It should chose the best treatment methods according to the tricuspid valve disease, while do the treatment with heart malformations.
, 百拇医药
[Key words] Tricuspid valve; Deformity; Surgical treatment; Valvuloplasty; Valve replacement
三尖瓣下移畸形(ebstein malformation)是一种临床上少见的复杂性心脏畸形，其主要的治疗方法为手术治疗。我科从2003年1月～2010年12月共对42例三尖瓣下移畸形患者行手术治疗，其中三尖瓣成形术34例(包括6例加双腔腔肺分流术)，三尖瓣置换术8例；矫治合并畸形中房间隔缺损或卵圆孔未闭30例，室间隔缺损4例，临床效果良好，现总结报道如下：
1 资料与方法
1.1 一般资料
本组34例三尖瓣成形术患者中，男26例，女16例；年龄2～46岁，平均(21.8±7.2)岁；体重8～76 kg，平均(46.5±10.3)kg；术前血红蛋白含量102～251 g/L，平均(140.8±25.1)g/L；红细胞压积33%～68%，平均(41.3±9.8)%；术前有明显的活动性呼吸困难10例，活动后心悸4例，有发绀及杵状指7例；胸骨左缘和(或)剑突下可闻及收缩期杂音。心电图检查提示完全性右束支传导阻滞或不完全性右束支传导阻滞10例。超声心动图提示三尖瓣均有中-重度返流；测量三尖瓣隔瓣下移12～54 mm，平均(30.0±8.2)mm；后瓣下移10～50 mm，平均(24.0±5.2)mm；前瓣下移平均(7.0±5.2)mm，有1例下移51 mm。合并房间隔缺损30例，室间隔缺损4例。心功能(YAHA分级)为Ⅱ级20例，Ⅲ级8例，Ⅳ级6例。
, 百拇医药
1.2 手术方法
手术均在全麻、中低温体外循环下进行。取胸骨正中切口，全身给予肝素化(3.5 mg/kg)后，行升主动脉插管和上、下腔静脉插管，建立体外循环通道，右上肺静脉放置左心引流管加压。阻断钳阻断升主动脉，4℃冷血高钾停跳液顺灌灌停心脏，心脏表面置冰泥，主动脉阻断期间每30分钟灌注半量心肌保护液。在右心房作平行房室沟的切口，拉开心脏探查三尖瓣前、后、隔各瓣及其瓣下结构的发育情况，探查右心室大小及其房化的程度，左心室发育状况及其他合并心内畸形情况，以便决定手术方式。体外循环时间为56～260 min，平均(94.0±38.1)min；阻断主动脉30～93 min，平均(70.0±10.2)min。
共行三尖瓣成形术34例，其中用水平房化右室折叠三尖瓣成形术法横行折叠房化右室22例，加Devega或Kay法成形8例；用垂直房化心室折叠三尖瓣成形术法纵行折叠房化右室12例，加Devega或Kay法成形4例；另外取用自体心包片加宽隔瓣2例，应用Gore-Tex人工腱索2例，应用Carpentier人工瓣环6例。行三尖瓣成形术加双腔腔肺分流术6例；均于心复跳后，上腔静脉与右肺动脉端侧吻合。三尖瓣置换术8例，采用CarboMedics双叶机械瓣31号2例，29号2例；采用Medtronic生物瓣31号4例。全组均用带垫涤纶线行间断褥式缝合，完整切除病变的三尖瓣及瓣下结构组织等，缝合时将Koch三角均保留在右心房。矫治合并畸形：房间隔缺损30例，室间隔缺损4例，均于同期行直接修补术。全组术后均安装心外膜临时起搏导线备用。, 百拇医药(余观水 钟志敏 胡楝 刘超 周启付)