Surgery for Congenital Heart Disease, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany.
Department for Pediatric Cardiology, University Medical Center Hamburg-Eppendorf, University Heart & Vascular Center Hamburg, Hamburg, Germany.
Thorac Cardiovasc Surg. 2021 Dec;69(S 03):e48-e52. doi: 10.1055/s-0041-1735457. Epub 2021 Nov 10.
Partial detachment of the septal and anterior leaflets of the tricuspid valve (TV) is a technique to visualize a perimembranous ventricular septal defect (VSD) for surgical closure in cases where the VSD is obscured by TV tissue. However, TV incision bears the risk of causing relevant postoperative TV regurgitation and higher degree atrioventricular (AV) block. A total of 40 patients were identified retrospectively in our institution who underwent isolated VSD closure between January 2013 and August 2015. Visualization of the VSD was achieved in 20 patients without and in 20 patients with additional partial detachment of the TV. The mean age of patients with partial tricuspid valve detachment (TVD) was 0.7 ± 0.1 years compared with 1 ± 0.3 years ( = 0.22) of patients without TVD. There was no difference in cardiopulmonary bypass time between patients of both groups (123 ± 11 vs. 103 ± 5 minutes, = 0.1). Cross-clamp time was longer if the TV was detached (69 ± 5 vs. 54 ± 4 minutes, = 0.023). There was no perioperative mortality. Echocardiography at discharge and after 2.5 years (2 months-6 years) of follow-up showed neither a postoperative increase of tricuspid regurgitation nor any relevant residual shunt. Postoperative electrocardiograms were normal without any sign of higher degree AV block. TVD offers enhanced exposure and safe treatment of VSDs. It did not result in higher rates of TV regurgitation or relevant AV block compared with the control group.
三尖瓣（TV）部分隔瓣和前瓣游离是一种技术，用于在 TV 组织遮挡膜周室间隔缺损（VSD）时，可视化 VSD 以进行手术闭合。然而，TV 切开术存在引起相关术后 TV 反流和更高程度房室（AV）传导阻滞的风险。我们机构回顾性地确定了 40 名在 2013 年 1 月至 2015 年 8 月期间接受单纯 VSD 闭合的患者。20 名患者在不游离 TV 的情况下实现了 VSD 可视化，20 名患者在游离 TV 的情况下实现了 VSD 可视化。有 TV 部分游离（TVD）的患者的平均年龄为 0.7±0.1 岁，而无 TVD 的患者为 1±0.3 岁（ = 0.22）。两组患者的体外循环时间无差异（123±11 与 103±5 分钟， = 0.1）。如果游离 TV，则夹闭时间更长（69±5 与 54±4 分钟， = 0.023）。围手术期无死亡。出院时和随访 2.5 年（2 个月-6 年）的超声心动图检查显示，术后 TV 反流既没有增加，也没有任何相关的残余分流。术后心电图正常，无任何更高程度的 AV 阻滞迹象。TVD 提供了增强的 VSD 暴露和安全治疗。与对照组相比，TVD 并未导致更高的 TV 反流或相关的 AV 阻滞发生率。
