目的 探讨三房心的临床分型、合并心内畸形、诊断和手术治疗方法.方法 21例三房心患儿,男9 例,女12 例,年龄1个月～9岁,平均(3.10 ±1.47)岁.单纯型5例,复杂型16 例.均在中度低温体外循环下行心内纠治术,经右心房-房间隔径路,仔细辨认左房内正常解剖结构与异常隔膜、房间隔缺损的解剖关系,完整切除左房异常隔膜,避免损伤左心房壁及二尖瓣膜,同期矫治其他合并心内畸形.结果 21 例患儿全部存活,畸形矫治满意,术后随访6 个月～3 年,恢复良好,心功能恢复至I～II 级.结论 三房心是一种少见的先天性心脏病,超声心动图检查对三房心有较高的诊断价值,MRI是另一具有较好临床应用价值的检查方法.手术关键在于术中探查,仔细辨认解剖关系,术中在不损伤左房壁的原则下彻底切除左房内异常隔膜并同时纠治合并心内畸形,手术治疗效果满意.%Objective To review the pathological morphology, clinical diagnosis and surgical treatment of cor triatriatum sinister. Methods Twenty-one patients with cor triatriatum sinister of age range from 1m to 9y (means 3.10 ± 1.47y), 9 males and 12 females were collected in this study. Five cases were classified as typical type (simple type) and 16 were atypical type (complicated type). All the patients underwent open heart surgery under hypothermic cardiopulmonary bypass(CPB). The surgery was performed by right atrium-septal approach in all 21 patients. Firstly, the normal anatomic structures of atrium sinistrum and their relations with the abnormal septum and atrial septal defect were identified, and then excision of the fibromuscular membrane in the left atrium was performed, the associated abnormalities were corrected at the same time. In the surgery, it was essential to avoid injury of the left atrium and the mitral valve. Results The surgical corrections were successful with good results in all 21 cases. All the patients were followed up from 6m to 3y after surgery and presented a fine postoperative recovery. The cardiac function of all patients reached to grade I-II. Conclusion Cor triatriatum is rare in congenital heart diseases. Two-dimensional or three-dimensional transthoracic (transoesophageal) echocardiography with color Doppler imaging and MRI are of great value in diagnosis of cor triatriatum. Good results can be accomplished with the surgical treatment to resect the fibromuscular in left atrium and to correct associated cardiac abnormalities simultaneously.
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