Ilbawi M N, Quinn K, Idriss F S, Riggs T W, DeLeon S Y, Muster A J, Paul M H
J Thorac Cardiovasc Surg. 1984 Jan;87(1):66-73.
Subpulmonary stenosis in transposition of the great arteries, resulting from a tricuspid valve pouch bulging into the left ventricular outflow tract through a ventricular septal defect, can be missed at the time of operation in the flaccid, nonbeating heart unless preoperative diagnosis has been established. In our experience, six patients were found to have this lesion. In four patients the tricuspid valve pouch was recognized preoperatively. At operation, retraction of the tricuspid valve pouch into the right ventricle, patch closure of the ventricular septal defect, and a Mustard procedure were performed in three patients; the fourth is awaiting correction following initial palliation with a subclavian-pulmonary shunt. In the other two, the ventricular septal defect was partially or completely obliterated by a tricuspid valve pouch that was missed preoperatively and during exploration at the time of the Mustard procedure. Residual left ventricular outflow tract obstruction was subsequently corrected with a left ventricle-pulmonary artery valved conduit. Echocardiographic and angiocardiographic examinations offer helpful signs for the diagnosis of tricuspid valve pouch. Transatrial retraction of the redundant tricuspid valve tissue into the right ventricle, patch closure of the ventricular septal defect, and Mustard operation are the procedures of choice. A left ventricle-pulmonary artery valved conduit may be required for residual unresectable left ventricular outflow tract obstruction.
大动脉转位中的肺动脉瓣下狭窄，是由于三尖瓣囊袋通过室间隔缺损凸入左心室流出道所致，在心脏松弛、停跳时进行手术时可能会被漏诊，除非术前已确诊。根据我们的经验，有6例患者存在这种病变。其中4例患者术前识别出了三尖瓣囊袋。手术时，3例患者进行了将三尖瓣囊袋回缩至右心室、用补片闭合室间隔缺损以及Mustard手术；第4例患者在最初采用锁骨下动脉-肺动脉分流术进行姑息治疗后等待矫正。另外2例患者，室间隔缺损被术前及Mustard手术探查时漏诊的三尖瓣囊袋部分或完全闭塞。随后用左心室-肺动脉带瓣管道矫正了残留的左心室流出道梗阻。超声心动图和心血管造影检查为三尖瓣囊袋的诊断提供了有用的征象。将多余的三尖瓣组织经心房回缩至右心室、用补片闭合室间隔缺损以及Mustard手术是首选的手术方法。对于残留的无法切除的左心室流出道梗阻，可能需要使用左心室-肺动脉带瓣管道。
