锥形成形技术治疗三尖瓣下移畸形19例临床分析  

Cone Reconstruction for Tricuspid Valve in 19 Patients with Ebstein's Anomaly: A Clinical Analysis

作　　者：隋润钤[1] 訾捷[1] 李勇[1] 李德才[1] 王安彪[1] 

机构地区：[1]山东大学附属省立医院心脏外科,济南250021

出　　处：《中国胸心血管外科临床杂志》2016年第7期688-691,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨锥形成形技术治疗三尖瓣下移畸形（Ebstein畸形）的手术方法,总结其早期临床效果。方法 回顾性分析2011年12月至2014年6月我院19例应用锥形成形技术治疗Ebstein畸形患者的临床资料,其中男8例、女11例,年龄3~53（24.7±18.5）岁,其中6例术前经心电图或心电生理检查诊断有心律失常（包括B型预激综合征合并心房颤动4例,阵发性室上性心动过速2例）。结果 1例患儿术前有重度紫绀,术后出现低心排血量综合征不能脱离体外循环死亡,其余患者术后恢复顺利。术后心房纤颤合并频发室性早搏1例,给予利多卡因及胺碘酮治疗后恢复窦性心律。所有患者复查超声心动图提示：良好的右心室形态及三尖瓣功能,轻度反流11例,无反流或微量反流7例。所有患者随访5~30个月,术后心功能恢复至Ⅰ级10例,Ⅱ级8例,未见术后早期死亡。结论 锥形成形技术矫治Ebstein畸形有较好的近期疗效,该手术能够重塑无功能的房化右心室,降低手术死亡率,改善三尖瓣反流,恢复术后心功能。Objective We sought to review our experience of cone reconstruction for tricuspid valve repair and to evaluate this therapeutic approach for patients with Ebstein＇s anomaly, to report early clinical outcomes. Methods We retrospectively analyzed the clinical data of 19 consecutive patients underwent cone reconstruction technique in our hospital between December 2011 and June 2014 year. There were 8 males and 11 females at mean age 24 years（ ranged from 3 months to 53 years）. Six patients were diagnosed by electrocardiography or electrophysiology examination, including 4 patients with B type Wolff-Parkinson-White syndrome and atrial fibrillation, 2 patients with paroxysmal supraventricular tachycardia. Results There was one patient of severe cyanosis hospital death for low cardiac output syndrome depending on cardiopulmonary bypass. The remaining patients were recovered smoothly. Atrial fibrillation associated with frequent ventricular premature, restoration of sinus rhythm with lidocaine and amiodarone occurred in one patient. Early postoperative echocardiograms showed good ventricular morphology and reduction in tricuspid regurgitation（TR） grade. Eleven patients were with mild regurgitation and 7 patients without or with trace amounts of regurgitation. All patients were followed up for 5-30 months. And postoperative cardiac function recovered to grade Ⅰ in 10 patients and grade Ⅱ in 8 patients. None of patients needed re-operation. Conclusions The cone reconstruction technique shows low in-hospital mortality and complication rate, reducing TR, restoring right ventricular function, allowing reverse remodeling of the heart. Early postoperative follow-up shows improvement in patients＇ clinical outcome and low incidence of re-operation.

关 键 词：EBSTEIN畸形 三尖瓣 外科治疗 围手术期 

分 类 号：R654.2[医药卫生—外科学]