三尖瓣适当切开技术在婴幼儿心脏不停跳室间隔缺损修补术中的应用

目的：探讨三尖瓣适当切开（TVD）技术在婴幼儿心脏不停跳室间隔缺损（VSD）修补手术中的应用价值。方法将589例行心脏不停跳 VSD 修补术的婴幼儿按是否采用 TVD 技术分为2组：TVD 组158例采用 TVD 技术，非 TVD 组431例未采用 TVD 技术。比较2组体外循环（TEE）时间、住院时间，在术前与术后7 d、1年行心脏彩超检查，记录术后残余漏发生率，术后7 d、1年三尖瓣反流（TR）发生率。结果围手术期无死亡病例。392例进行补片修补，其中 TVD 组129例，非 TVD 组263例；197例直接缝合，其中 TVD 组29例，非 TVD 组168例。66例合并畸形患儿同期进行矫治。术后并发完全性房室传导阻滞：TVD 组0例，非 TVD 组4例，均于术后10 d 内恢复窦性。随访1年，2组病例均无远期死亡，均无因 TR 再手术，非 TVD 组2例因残余漏再手术。2组 TEE 时间、住院时间比较差异无统计学意义（P ＞0．05）；TVD 组术后残余漏及术后7 d、1年 TR 发生率均较非 TVD 组显著减少（P ＜0．05）。结论在婴幼儿心脏不停跳室间隔缺损修补术中，应用 TVD 技术安全、有效，能改善 VSD 的暴露，减少残余漏发生，保护三尖瓣瓣叶结构，减少术后严重 TR 的发生。

Application of Tricuspid Valve Detachment in Infants Undergoing Beating Heart Surgery for Ventricular Septal Defect

Objective To investigate the clinical value of tricuspid valve detachment（TVD）in infants undergoing beating heart surgery for ventricular septal defect（VSD）.Methods A total of 589 infants undergoing beating heart surgery for ventricular septal defect were divided into two groups：TVD group（n=158）and non-TVD group（n=431）.The extracorporeal circulation time and hospital stay were compared between the two groups.Echocardiography was performed be-fore and 7 days and 1 year after operation to record the incidences of residual leakage and tricuspid regurgitation（TR）.Results No death occurred in all patients.Among the 589 patients,392 re-ceived patch repair（including 129 in TVD group and 263 in non-TVD group）,and 197 received di-rect suture（including 29 in TVD group and 168 in non-TVD group）.Sixty-six infants with de-formity were treated at the same time.No patients had postoperative complete atrioventricular block in TVD group.However,4 patients in non-TVD group had postoperative complete atrioven-tricular block but achieved the restoration of sinus rhythm within 10 days after operation.After follow-up of 1 year,no patients died and received reoperation for TR in both groups.In non-TVDgroup,2 patients underwent reoperation for residual leakage.There were no significant differences in extracorporeal circulation time and hospital stay between the two groups（P 〉0.05）.Compared with non-TVD group,the incidence of postoperative residual leakage and incidence of TR 7 days and 1 year after operation significantly decreased in TVD group（P 〈0.05）.Conclusion TVD is safe and effective for improving the VSD exposure,reducing the incidence of residual leakage,pro-tecting the structure of tricuspid valve leaflets and decreasing the occurrence of serious postopera-tive TR in infants undergoing beating heart surgery for VSD.