Lin Ying-Jui, Chang Jen-Ping, Chien Shao-Ju, Liang Chi-Di, Huang Chien-Fu, Kao Chiung-Lun
Division of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan, Republic of China.
Tex Heart Inst J. 2012;39(6):806-10.
Tricuspid valve detachment has been used for decades in the repair of type II ventricular septal defects (VSDs); however, the procedure can damage the tricuspid valve and conduction system. We retrospectively reviewed 177 consecutive type II VSD repairs performed at our hospital from 1997 through 2004. Patients were included if they had symptoms, pulmonary hypertension, or a Qp/Qs ratio>1.5: 86 underwent tricuspid valve detachment (TVD group) and 84 underwent VSD repair without this detachment (non-TVD group). There was no significant difference between groups in age, body weight, VSD size, Qp/Qs ratio, follow-up duration, or incidence of residual shunting. Cross-clamp times (109.6±42.6 vs 92.2±38.1 min) and cardiopulmonary bypass times (155.1±53.8 vs 137±47 min) were longer in the TVD group. No patients developed tricuspid stenosis or heart block. After excluding patients who underwent tricuspid repair, we found similar grades of postoperative tricuspid regurgitation in both groups. In applying our novel criterion (last postoperative regurgitation grade minus preoperative regurgitation grade) to evaluate changes between preoperative and postoperative tricuspid regurgitation, we found significant deterioration in the non-TVD group (P=0.018). Had conventional evaluation methods been used, severity in the groups would not have differed significantly. Our method enables additional evaluation of late tricuspid function in individual patients. Tricuspid valve detachment is safe for type II VSD repair and has no adverse effect on late tricuspid valve function. In addition, we recommend the interrupted-suture technique for leaflet reattachment.
几十年来，三尖瓣分离术一直用于Ⅱ型室间隔缺损（VSD）的修复；然而，该手术可能会损伤三尖瓣和传导系统。我们回顾性分析了1997年至2004年在我院连续进行的177例Ⅱ型VSD修复手术。纳入标准为有症状、肺动脉高压或Qp/Qs比值>1.5的患者：86例行三尖瓣分离术（TVD组），84例行未进行该分离术的VSD修复术（非TVD组）。两组在年龄、体重、VSD大小、Qp/Qs比值、随访时间或残余分流发生率方面无显著差异。TVD组的主动脉阻断时间（109.6±42.6 vs 92.2±38.1分钟）和体外循环时间（155.1±53.8 vs 137±47分钟）更长。无患者发生三尖瓣狭窄或心脏传导阻滞。在排除接受三尖瓣修复的患者后，我们发现两组术后三尖瓣反流程度相似。在应用我们的新标准（术后最后反流程度减去术前反流程度）评估术前和术后三尖瓣反流的变化时，我们发现非TVD组有显著恶化（P=0.018）。如果使用传统评估方法，两组的严重程度不会有显著差异。我们的方法能够对个体患者的晚期三尖瓣功能进行额外评估。三尖瓣分离术用于Ⅱ型VSD修复是安全的，对晚期三尖瓣功能没有不良影响。此外，我们推荐采用间断缝合技术进行瓣叶重新附着。
