先天性矫正型大动脉转位行形态三尖瓣置换术  

Outcomes of the morphologic tricuspid valve replacement for patients with congenitally corrected transposition of the great arteries

作　　者：刘延华[1] 梁志强[1] 何发明[1] 郑向阳[1] 宋鹏[1] 王磊[1] 王平凡[1] 

机构地区：[1]河南省胸科医院心血管外科, 郑州市450008

出　　处：《中国心血管病研究》2014年第2期109-111,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨先天性矫正型大动脉转位（C CTGA）患者行形态三尖瓣置换的手术适应证及术后效果.方法 2007年至2012年河南省胸科医院收治CCTGA患者6例,男性5例,女性1例,年龄28～47（34.0±5.2）岁,术前心功能Ⅱ级1例、Ⅲ级5例（NYHA分级）,术前合并室间隔缺损1例、房颤1例、完全性左束支传导阻滞1例、完全性右束支传导阻滞1例、Ⅰ°房室传导阻滞2例.术前形态右心室射血分数（49.0±13.2）％.6例患者均施行形态三尖瓣置换术,术后随访患者心功能、形态右心室射血分数等指标.结果 全组无住院死亡.随访13～72个月,1例患者术后41个月因主动脉夹层死亡,余5例均存活.人工瓣膜功能正常,心功能较术前明显改善,术后1年时心功能Ⅰ级2例、Ⅱ级3例、Ⅲ级1例（NYHA分级）,与术前比较差异有统计学意义（P＜0.05）.术后1年时形态右心室射血分数（48.0±5.6）％,与术前比较差异无统计学意义（P＞0.05）.结论 CCTGA患者行形态三尖瓣置换手术效果满意,能够防止形态右心室功能的进一步损害.Objective To investigate the surgical indications and the results of morphologic tricuspid valve replacement for congenitally corrected transposition of the great arteries （CCTGA）. Methods From 2007 to 2012, 6 cases with CCTGA were treated in Henan Chest Hospital. There were 5 male and 1 female,aged from 28 to 47 years （34.0±5.2）years. Of the 6 cases, 1 was in grade Ⅱ and 5 were in grade m according to New York Heart classification（NYHA）. There was 1 complicated with ventricular septal defect, 1 complicated with atrial fib- rillation, 1 complicated with complete left bundle branch block, 1 complicated with complete right bundle branch block, 2 complicated with first degree atrioventricular block. The preoperative mean morphologic right ventricle ejection fraction was （49.0±13.2）%. 6 patients had undergone morphologic tricuspid valve replacement. Postopera- tive indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results There was no death in hospital. During the follow-up of 13-72 months, 1 patient died of aortic dissection 41 months after the surgery, the other 5 patients survived with normal function of the prosthetic valve. The cardiac function of the cases was significantly improved. When one year after the surgery, 2 was in grade I , 3 was in grade Ⅱ and 1 were in grade Ⅲ according to New York Heart classification （NYHA）, while the differences were significant after treatment. There was no statistical significance between preoperative and postoperative mean mor- phologic right ventricle ejection fraction when one year after the surgery. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function with satisfactory results.

关 键 词：先天性矫正型大动脉转位 形态三尖瓣置换 形态右心室功能 

分 类 号：R654.2[医药卫生—外科学]