Department of Pediatric Cardiac Surgery, Sakakibara Heart Institute, Tokyo, Japan.
Ann Thorac Surg. 2011 Nov;92(5):1767-73; discussion 1773. doi: 10.1016/j.athoracsur.2011.04.025. Epub 2011 Jul 23.
Presently, there are wide variations in cardiac anatomies requiring single ventricular palliation and these variations may have an impact on the incidence of atrioventricular valve regurgitation.
In all, 363 patients underwent single ventricular palliation (1978 to 2008). Hearts were first classified into single right ventricle (156), single left ventricle (140), and two ventricles (63); and secondly into single mitral (90), single tricuspid (64), two separate valves (110), and common atrioventricular valves (95).
The incidence of atrioventricular valve regurgitation and the necessity of repair were the highest with common atrioventricular valves, followed by tricuspid and mitral valves (p < 0.0001). The success rate (postoperative regurgitation of mild or less) of repair was similar (p = 0.9800). Estimated survival for patients having moderate or greater atrioventricular valve regurgitation was similar to the rest of the patients (p = 0.8705). Patients were more likely to have progressive mitral regurgitation in the presence of both mitral and tricuspid valves, compared with single mitral valve (p = 0.0207). There were 2 patients who had severe mitral regurgitation; both had a nonsystemic left ventricle isolated from the circulation by malposition of the great arteries and restrictive/remote ventricular septal defect. In contrast, coexisting mitral valves reduced the incidence of potential tricuspid regurgitation (p = 0.0012).
If performed properly, atrioventricular valve repair may neutralize the risk of regurgitation regardless of the valve morphology. The effort to incorporate the mitral valve into the systemic circulation may be important to reduce tricuspid regurgitation. The effort to decompress a nonsystemic left ventricle, if present, may be important to avoid unfavorable ventricular interactions on the mitral valve.
目前，需要单心室姑息治疗的心脏解剖结构差异很大，这些差异可能会对房室瓣反流的发生率产生影响。
共有 363 例患者接受了单心室姑息治疗（1978 年至 2008 年）。首先将心脏分为单右心室（156 例）、单左心室（140 例）和双心室（63 例）；其次分为单二尖瓣（90 例）、单三尖瓣（64 例）、两个独立瓣膜（110 例）和共同房室瓣（95 例）。
共同房室瓣的房室瓣反流发生率和修复必要性最高，其次是三尖瓣和二尖瓣（p<0.0001）。修复的成功率（术后轻度或以下反流）相似（p=0.9800）。中度或以上房室瓣反流患者的估计生存率与其余患者相似（p=0.8705）。与单二尖瓣相比，同时存在二尖瓣和三尖瓣的患者更容易发生进行性二尖瓣反流（p=0.0207）。有 2 例患者出现严重二尖瓣反流；两者均因大动脉错位和限制性/远侧室间隔缺损使非系统性左心室与循环隔离。相比之下，同时存在二尖瓣可降低潜在三尖瓣反流的发生率（p=0.0012）。
如果操作得当，房室瓣修复可以中和反流的风险，而与瓣膜形态无关。将二尖瓣纳入体循环的努力对于减少三尖瓣反流可能很重要。如果存在，减轻非系统性左心室的压力可能对于避免二尖瓣上不利的心室相互作用很重要。
