利用自体心包片修复三尖瓣治疗Ebstein畸形

摘要

目的 介绍一种利用自体心包片修复三尖瓣治疗Ebstein畸形的新方法和临床经验.方法 2008年1月至2012年6月手术治疗8例Ebstein畸形患者,根据Carpentier病理分型,B型1例,C型6例,D型1例.术中在Carpentier术式的基础上,应用戊二醛处理过的自体心包片重建前瓣、后瓣,增加瓣叶对合面积.结果 围术期无死亡.三尖瓣成形术后超声心动图示三尖瓣反流明显减轻.随访3～48个月,超声心动图表现明显改善,所有患者心功能均恢复至Ⅰ～Ⅱ级.结论 利用自体心包片修复三尖瓣治疗Ebstein畸形拓宽了瓣膜成形的适应证,能够更好地恢复三尖瓣的解剖形态及功能.%Objective To introduce a new method for surgical treatment of Ebstein's anomaly by tricuspid valvuloplasty applying autologous pericardium and summarize the clinical experience. Methods Eight patients of Ebstein's anomaly were treated from Jan. ,2008 to June,2012,and divided into one of type B,6 of type C and one of type D based on the Carpentier' s criteria for pathological classification. During the operations, autologous pericardia treated with glutaraldehyde were used to rebuild anterior and posterior valves, and increase the closing area of valves on the basis of the Carpentier method. Results There was no death during the perioperative period. Tricuspid regurgitation was mitigated significantly as indicated by ultrasonic cardiograms after tricuspid valvuloplasty. In the follow-up period of 3 to 48 months, the ultrasonic cardiogram performance was significantly improved and the heart function was restored to NYHA Class I or Ⅱ in all the patients. Conclusions The application of tricuspid valvuloplasty to the treatment of Ebstein s anomaly by autologous pericardium broadens indications for valvoplasty,and is more effective in restoring the anatomical form and functionality of the tricuspid.