Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA.
Ann Thorac Surg. 2011 Aug;92(2):685-90; discussion 690. doi: 10.1016/j.athoracsur.2011.03.023.
Adequate exposure of a ventricular septal defect (VSD) is critically important to obtaining a satisfactory repair. Some surgeons have advocated a circumferential incision on the tricuspid valve. For 20 years we have used a radial incision of the tricuspid valve when added exposure is required.
All patients undergoing VSD repair at Children's Memorial Hospital (Chicago, IL) were identified from our database. Operative records were reviewed to determine details of exposure. Follow-up patient and echocardiography data were obtained from the medical record.
Between January 1995 and March 2010, 366 isolated VSDs were repaired, including 341 perimembranous, 15 muscular, 5 inlet, and 5 inlet-muscular VSDs. A radial tricuspid valve incision was used in 230 patients (63%). Mean times (minutes) were 97±24 for cardiopulmonary bypass and 66±18 for cross-clamp, with no significant difference between groups (p=0.59 and p=0.96, respectively). No operative deaths occurred. Follow-up echocardiograms were available for 150 patients at a mean of 3.5 years. Tricuspid regurgitation was rated as none or trivial in 97 (65%), mild in 45 (30%), and moderate in 8 (5%). The degree of tricuspid regurgitation was similar between patients whose tricuspid valve was and was not incised.
Radial incision of the tricuspid valve enhances exposure for safe VSD closure and adds little complexity to the case. Its use in our series did not lead to increased tricuspid valve dysfunction, and it was durable at midterm echocardiographic assessment.
充分暴露室间隔缺损（VSD）对于获得满意的修复至关重要。一些外科医生主张在三尖瓣上做环形切口。20 年来，当需要额外暴露时，我们一直使用三尖瓣的放射状切口。
从我们的数据库中确定了在芝加哥儿童纪念医院（Chicago, IL）接受 VSD 修复的所有患者。回顾手术记录以确定暴露的详细信息。从病历中获得了随访患者和超声心动图数据。
1995 年 1 月至 2010 年 3 月期间，共修复了 366 例孤立性 VSD，其中 341 例为膜周部、15 例为肌部、5 例为流入部和 5 例为流入-肌部 VSD。230 例（63%）患者采用了三尖瓣放射状切口。体外循环时间（分钟）的平均值为 97±24，体外循环时间（分钟）的平均值为 66±18，两组之间无显著差异（分别为 p=0.59 和 p=0.96）。无手术死亡。在平均 3.5 年的时间里，150 例患者的超声心动图检查结果可用。97 例（65%）患者的三尖瓣反流为无或轻度，45 例（30%）患者为轻度，8 例（5%）患者为中度。三尖瓣反流程度在未切开和切开三尖瓣的患者之间相似。
三尖瓣放射状切口增强了 VSD 闭合的暴露，并且对手术过程增加的复杂性很小。在我们的系列中，它的使用并未导致三尖瓣功能障碍增加，并且在中期超声心动图评估时具有耐久性。
