改良术式矫正Ebstein畸形

目的　报告改良术式改善重症Ebstein畸形隔、后瓣下移明显、前瓣发育差、功能右室小、手术矫正困难者的手术疗效。方法　 1997年 6月至 1999年 8月用改良术式对 8例Ebstein畸形施行了手术矫正 (改良组 )。并与采用Hardy、Carpentier等术式矫正及三尖瓣置换共 5 5例病人 (对照组 )的疗效进行了跟踪随访比较。结果　改良组无死亡 ,与对照组比较 ,术后心功能的恢复及三尖瓣反流的改善效果更好。结论　改良术式扩大了右心室形态及三尖瓣重建的手术适应证范围 ,使部分重症病人避免了瓣膜置换术的并发症。对隔、后瓣下移明显且前瓣发育不良的病人消除了术后三尖瓣反流并在保持左、右心室几何形态和功能方面效果显著

A modified procedure for correct in of Ebstein anomaly

Objective To evaluate the clinical effect of a modified procedure for severe Ebstein anomaly. Method From June 1997 to August 1999, the modified procedure of Carpentier making full use of posterior and septal leaflets was used in 8 patients with Ebstein anomaly (research group). Other surgical procedures, including Hardy procedure, Carpentier procedure, and tricuspid valve replacement were used in 55 patients (control group). The follow up data and results of the two groups were studied and compared. Result There was no operative mortality in research group. Recovery of heart function and correction of tricuspid insufficiency were improved significantly in research group than those in control group. Conclusion The modified procedure for Ebstein anomaly can extend the surgical indication to the reconstruction of right ventricular geometry and tricuspid valve. Valve replacement may be avoided in some severe Ebstein anomaly. The incidence of postoperative insufficiency can decreased. The left and right ventricular geometry can be preserved and heart function can recover better in the patients with obviously downward displacement of septal and posterior leaflets and an under developed anterior leaflet.