改良三尖瓣隔瓣成形术在儿童完全性房室间隔缺损中的应用及随访分析  

Application and follow-up study of modified tricuspid septal valvuloplasty in children with complete atrioventricular septal defect

作　　者：范明 莫绪明[2] 郁迪[2] 戚继荣[2] 孙剑[2] 彭卫[2] 武开宏[2] Fan Ming;Mo Xuming;Yu Di;Qi Jirong;Sun Jian;Peng Wei;Wu Kaihong(Department of Thoracic and Cardiovascular Surgery,Affiliated Children's Hospital of Jiangnan University,Wuxi 214000,China;Department of Thoracic and Cardiovascular Surgery,Nanjing Children's Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]江南大学附属儿童医院(无锡市儿童医院)心胸外科,无锡214000 [2]南京医科大学附属儿童医院心胸外科,南京210000

出　　处：《中华胸心血管外科杂志》2024年第4期201-206,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：无锡市"太湖人才计划"高端医学专家团队(GDTD202105);无锡市太湖人才计划高层次人才培养项目(2020THRC-GD-YQJ)。

摘　　要：目的总结并评价改良三尖瓣隔瓣成形技术处理完全性房室间隔缺损患儿三尖瓣隔瓣的疗效。方法选取2017年1月至2022年1月南京市儿童医院心胸外科治疗完全性房室间隔缺损患儿共计96例,术中三尖瓣处理均采用改良三尖瓣隔瓣成形术,通过超声心动图比较患儿术前及术后三尖瓣的反流程度以及右心室大小,评估改良三尖瓣隔瓣成形术的早中期疗效。结果96例患儿随访(32.04±17.62)个月,早期死亡3例,晚期死亡2例,8例患儿需二次手术。患儿术后1年、2年、5年免于三尖瓣中度以上反流率分别为:(97.8±1.5)%,(89.7±3.8)%,(78.5±11.0)%。术后超声心动图显示其末次随访时三尖瓣反流程度、右心室大小与术前相比均明显改善,心功能分级(NYHA分级)亦有明显好转。结论改良三尖瓣隔瓣成形术治疗完全性房室间隔缺损患儿三尖瓣病变,早中期疗效满意,具有很好的临床应用价值。Objective To summarize the results of modified tricuspid septal valvuloplasty(MTSVP)in the treatment of complete atrioventricular septal defect(CAVSD)in children and evaluate its clinical effect.Methods From January 2017 to January 2022,a total of 96 children with CAVSD were treated by cardiothoracic surgery in Nanjing Children's Hospital.During the operation,MTSVP was used to treat tricuspid valve(TV).The degree of tricuspid regurgitation(TR)and the size of right ventricle before and after operation were compared by echocardiography to evaluate the early and medium-term efficacy of MTSVP.Results The whole group of 96 children were followed up,including 3 cases of early death and 2 cases of late death.The average follow-up was(32.04±17.62)months,and 8 cases needed to reoperation.The overall cumulative incidence of TR deemed moderate or greater at 1,3,5 years were(97.8±1.5)%,(89.7±3.8)%and(78.5±11.0)%.Postoperative echocardiography showed that the degree of TR and the size of right ventricle were significantly improved compared with those before operation,and the New York Heart Association functional class(NYHA class)was also significantly improved.Conclusion The MTSVP has a satisfactory midterm effect on the management of TV in children with CAVSD,and has a good clinical application value.

关 键 词：改良三尖瓣隔瓣成形术 完全性房室间隔缺损 儿童 

分 类 号：R726.5[医药卫生—儿科]