Tatebe S, Miyamura H, Watanabe H, Sugawara M, Eguchi S
Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Japan.
J Card Surg. 1995 Sep;10(5):564-8. doi: 10.1111/j.1540-8191.1995.tb00633.x.
Detachment of the septal leaflet of the tricuspid valve is an alternative technique for obtaining complete visualization of a perimembranous ventricular septal defect (VSD) in cases where the VSD is obscured by the chordae tendineae or a pouch formation of the septal leaflet. This method presents theoretical concerns because it has the potential for causing postoperative valvular insufficiency. We therefore evaluated valvular function in patients who underwent VSD closure with detachment of the tricuspid valve. In a consecutive series of 153 patients who underwent VSD closure using a transatrial approach, 13 had incision of the tricuspid valve. Follow-up echocardiographic studies were performed on these patients at least 1 year following operation. There were no operative deaths. Color Doppler echocardiography revealed no residual shunt in any of these patients. Ten patients had no evidence of tricuspid stenosis or regurgitation. One patient had trivial tricuspid regurgitation. Moderate tricuspid regurgitation was observed in two patients of these, one patient was a small infant who had a VSD complicated by pulmonary hypertension. The other patient had a VSD with a mitral cleft, pulmonary hypertension, and Down's syndrome. The incised tricuspid valve was resuspended by solely running sutures. In conclusion, detachment of the tricuspid valve is a safe and useful method for adequate exposure of a VSD. However, this method should be avoided in patients with Down's syndrome and in small infants. Furthermore, repair of the incised valve should not be performed using only running sutures.
在室间隔缺损（VSD）被腱索或隔叶袋状结构遮挡的情况下，三尖瓣隔叶分离术是一种获得膜周部室间隔缺损完整可视化的替代技术。该方法存在理论上的担忧，因为它有可能导致术后瓣膜功能不全。因此，我们评估了接受三尖瓣隔叶分离术进行VSD闭合的患者的瓣膜功能。在连续153例采用经心房入路进行VSD闭合的患者中，有13例进行了三尖瓣切开术。术后至少1年对这些患者进行了超声心动图随访研究。无手术死亡病例。彩色多普勒超声心动图显示这些患者均无残余分流。10例患者无三尖瓣狭窄或反流证据。1例患者有轻微三尖瓣反流。其中2例患者观察到中度三尖瓣反流，1例是患有VSD合并肺动脉高压的小婴儿。另1例患者有VSD合并二尖瓣裂、肺动脉高压和唐氏综合征。切开的三尖瓣仅通过连续缝合进行重新悬吊。总之，三尖瓣隔叶分离术是充分暴露VSD的一种安全且有用的方法。然而，唐氏综合征患者和小婴儿应避免使用该方法。此外，切开瓣膜的修复不应仅使用连续缝合进行。
