Yilmaz A T, Arslan M, Kuralay E, Demrkiliç U, Ozal E, Tatar H, Oztürk O Y
Gülhane Military Medical Academy, Department of Cardiovascular Surgery, Ankara-Turkey.
J Card Surg. 1996 Sep-Oct;11(5):363-7. doi: 10.1111/j.1540-8191.1996.tb00064.x.
This study examined the septal cleft and septal commissure of the left atrioventricular (AV) valve, which are two different anatomical structures.
We presented 36 cases of adult partial atrioventricular septal defect. A distinction was made between patients based on the anatomy of the anterior leaflet of the left AV valve. The left AV valve appeared to be normal or to have minimal radial openings from the free edge of the anterior leaflet of the left AV valve in 10 patients (28%). There was a septal commissure structure in 8 (22%), and a septal cleft structure in 18 (50%) patients. In the commissure type anatomy, leaflet coaptation was usually adequate and no or mild degree of left AV regurgitation existed preoperatively. Cleft type structure usually was associated with some degree of left AV regurgitation. Attempts were made to close the septal clefts and leave the septal commissures unsutured during the repair of the partial AV septal defects.
We have not found any increase of left AV regurgitation in patients with commissures during the follow-up period. Closure of the cleft successfully eliminated regurgitation. Long-term results for septal cleft and septal commissure after repair of partial AV septal defect were excellent with survival of 100% and freedom from reoperation of 100% at mean 6.5 years.
Septal cleft and septal commissure should be considered two different structures. Repairing procedures for left AV valve abnormalities associated with partial AV septal defect should only be done in patients who have cleft type of leaflet structure.
本研究检查了左房室（AV）瓣的间隔裂和间隔连合，它们是两种不同的解剖结构。
我们呈现了36例成人部分房室间隔缺损病例。根据左AV瓣前叶的解剖结构对患者进行区分。10例患者（28%）的左AV瓣看起来正常或左AV瓣前叶游离缘有最小的放射状开口。8例（22%）有间隔连合结构，18例（50%）患者有间隔裂结构。在连合型解剖结构中，瓣叶对合通常足够，术前不存在或仅有轻度左房室反流。裂型结构通常与一定程度的左房室反流相关。在修复部分房室间隔缺损时，尝试关闭间隔裂而不缝合间隔连合。
在随访期间，我们未发现有间隔连合的患者左房室反流增加。裂隙关闭成功消除了反流。部分房室间隔缺损修复术后间隔裂和间隔连合的长期结果极佳，平均6.5年时生存率为100%，再次手术率为0%。
应将间隔裂和间隔连合视为两种不同的结构。与部分房室间隔缺损相关的左AV瓣异常的修复手术仅应在具有裂型瓣叶结构的患者中进行。
