Misumi H, Nakajima M, Koh E, Tokunaga H, Kurosawa H, Imai Y
Nihon Kyobu Geka Gakkai Zasshi. 1989 Sep;37(9):2029-34.
A case of straddling tricuspid valve associated with dextrocardia and VSD was presented. Closure of ventricular septal defect and tricuspid valve replacement were performed on this patient. Since the straddling septal leaflet of the tricuspid valve shared a posterior papillary muscle in the left ventricle with the posterior mitral leaflet, division of this papillary muscle was thought to induce papillary muscle dysfunction of both leaflet. Hence, the chordae of straddling tricuspid leaflet was detached from the shared papillary muscle and the ventricular septal defect was closed by a large pericardial patch. Because of peculiar anatomy of the conduction system in this situation, the junctional area of the inlet septum and tricuspid annulus was avoided from stitching in VSD closure. Suture through the tricuspid septal leaflet and pericardial patch for VSD were used for tricuspid valve replacement as well. The patient showed uneventful postoperative course without any conduction disturbance including the right bundle branch block.
本文报告1例合并右位心和室间隔缺损的骑跨三尖瓣病例。该患者接受了室间隔缺损修补术和三尖瓣置换术。由于三尖瓣的骑跨隔叶与二尖瓣后叶共用左心室的一个后乳头肌，因此认为切断该乳头肌会导致两个瓣叶的乳头肌功能障碍。因此，将骑跨三尖瓣叶的腱索从共用乳头肌上分离，并使用一大块心包补片关闭室间隔缺损。由于这种情况下传导系统的特殊解剖结构，在室间隔缺损修补时避免缝合流入道间隔与三尖瓣环的交界区。用于室间隔缺损修补的穿过三尖瓣隔叶和心包补片的缝线也用于三尖瓣置换。患者术后恢复顺利，未出现任何传导障碍，包括右束支传导阻滞。
