共查询到20条相似文献,搜索用时 11 毫秒
1.
Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure 总被引:3,自引:0,他引:3
Aeba R Katogi T Hashizume K Koizumi K Iino Y Mori M Yozu R 《The Annals of thoracic surgery》2003,76(4):1073-1077
BACKGROUND: Although temporary tricuspid valve detachment is useful for improved visualization of ventricular septal defect through right atriotomy, liberal use of this adjunct is not widely supported, mainly because of concerns about iatrogenic complications such as heart blocks and tricuspid valve dysfunction. The objective of this study was to determine whether liberal use of this adjunct can improve operative outcome. METHODS: Between January 1997 and March 2002, trans-atrial closure of isolated ventricular septal defect (conoventricular or canal type) was performed in 87 consecutive patients. Tricuspid valve detachment was used in 4 out of 44 patients (prudent-use group) and 19 out of 43 patients (liberal-use group) in the first and second half of this period, respectively (p = 0.0002). Patient demographics and use of other surgical and cardiopulmonary bypass techniques remained virtually unchanged during this period. RESULTS: In the prudent-use group, there was one operative death with prolonged bypass time and one residual defect that required reoperation; neither of these patients underwent tricuspid valve detachment. All other patients (both groups) were free from mortality and clinically significant complications, including heart block, tricuspid regurgitation, and residual defect. The liberal-use group had shorter cardiopulmonary bypass time than the prudent-use group (59 +/- 14 vs 67 +/- 22 minutes, p = 0.037). CONCLUSIONS: Tricuspid valve detachment should be used liberally for moderate- or even low-difficulty exposure of ventricular septal defect, regardless of patient background, because it is a safe and effective adjunct that can improve speed, programmability, reproducibility, and reliability. 相似文献
2.
3.
Neeraj Kumar Sunil Dixit Rajat Agrawal Rakesh Kumar Verma Vinay Krishna Jeevan Lal Sahni 《Indian Journal of Thoracic and Cardiovascular Surgery》2009,25(2):49-51
Background
Detachment of the Tricuspid Valve Leaflet (TVD) has been described for better access to repair Perimembranous Ventricular Septal Defects (pVSD). The present report is our early experience with which has been found to be safe and easy with reproducible results. 相似文献4.
5.
6.
7.
8.
Outcome following isolated tricuspid valve replacement. 总被引:5,自引:0,他引:5
A A Mangoni T G DiSalvo G J Vlahakes C A Polanczyk M A Fifer 《European journal of cardio-thoracic surgery》2001,19(1):68-73
OBJECTIVES: The clinical outcome of isolated tricuspid valve replacement is not well defined because this procedure is usually performed concomitantly with other valve surgery. METHODS: We retrospectively studied the short and long-term outcome of 15 consecutive patients (six men and nine women, aged 61+/-3 years) undergoing isolated tricuspid valve replacement from 1984 to 1996. The cause of valve dysfunction was rheumatic heart disease in 12 patients, healed endocarditis in two patients, and sarcoidosis in one patient. The tricuspid valve was stenotic in one patient, regurgitant in eight patients, and both stenotic and regurgitant in six patients. A St. Jude Medical prosthesis was placed in eight patients, Carpentier-Edwards in five patients, and Bj?rk-Shiley and Starr-Edwards in one patient each. RESULTS: The median survival was only 1.2 years. Three patients (20%) died < or =30 days after the surgery or before discharge, and six other patients (40%) died within 3 years of surgery. Anasarca was the only predictor of short-term mortality (P=0.03), while the predictors of long-term mortality were anemia (P=0.01), rheumatic heart disease (P=0.04), previous stroke (P=0.04), and previous mitral valve surgery (P=0.04). CONCLUSIONS: Isolated tricuspid valve replacement is characterized by a poor short and long-term outcome. 相似文献
9.
10.
Robicsek F 《The Annals of thoracic surgery》2006,81(2):788-788; author reply 789
11.
12.
13.
14.
V A Jebara C Acar P Dervanian A Farge M Sousa Uva P Julia J N Fabiani A Deloche P Blondeau A Carpentier 《The Journal of cardiovascular surgery》1992,33(2):253-255
Traumatic ventricular septal defects (TVSD) are rare complications of cardiac trauma. This report describes 3 cases of TVSD secondary to penetrating trauma in 2 patients and to blunt trauma in one case. Echocardiography confirmed the diagnosis in all cases. Surgical correction was performed in the 3 cases. In 2 patients associated tricuspid trauma was present requiring tricuspid valve repair. 相似文献
15.
16.
17.
Detachment of the anterior leaflet of the tricuspid valve to expose perimembranous ventricular septal defects 总被引:4,自引:0,他引:4
BACKGROUND: Detachment of the septal leaflet of the tricuspid valve has been described for better access to perimembranous ventricular septal defects. Detachment confined to the anterior leaflet is less known, although it provides a better exposure of the subaortic area and puts less jeopardy on the conduction tissues. METHODS: Data regarding 49 consecutive patients who had congenital perimembranous ventricular septal defect closure were retrospectively reviewed. Thirty-three patients (67%) underwent temporary detachment of the anterior leaflet of the tricuspid valve. The defect was closed with a Gore-Tex patch and a continuous suture. In 10 patients (29%), concomitant right ventricular outflow tract enlargement was performed. Follow-up was obtained in every patient (median time, 11 months; range, 2 to 26 months). RESULTS: No early or late death occurred. Closure of the ventricular septal defect was complete, with no more than trivial residual jet leaks found in perioperative echocardiography. All patients were in sinus rhythm. The tricuspid valve never showed more than mild insufficiency after repair. No patient showed subaortic obstruction. CONCLUSIONS: Detachment of the anterior leaflet of the tricuspid valve to expose the ventricular septal defect is a safe approach that allows rapid closure of the defect with a continuous suture and provides excellent results. 相似文献
18.
Myhre U Duncan BW Mee RB Joshi R Seshadri SG Herrera-Verdugo O Rosenthal GL 《The Annals of thoracic surgery》2004,78(1):204-208
Background
Apical ventricular septal defects (VSDs) are difficult to visualize through a transatrial approach, while the use of a left ventriculotomy may result in progressive ventricular dysfunction. Transcatheter closure has not been reliable, especially in small infants. Apical right ventriculotomy provides good exposure, preserves left ventricular function, and allows secure closure of apical VSDs.Methods
From November 1994 through April 2002, nine children, median age 8 months (range, 74 days to 2.5 years) underwent 10 operations for VSD closure via apical right ventriculotomy (one patient with a residual defect underwent successful VSD closure via a second apical right ventriculotomy). Two patients were status post pulmonary artery banding and two patients had previous unsuccessful attempts at closure via a transatrial approach.Results
There was no hospital mortality; there were 2 late deaths (78% survival; 95% confidence interval [CI], 45% to 94%), 3 months and 4 years postoperatively. Postoperative echocardiography demonstrated no residual VSDs in 3 and insignificant residual VSDs in 4 of the survivors. All survivors currently exhibit normal biventricular function during a median follow-up of 25 months (range, 11 to 104 months).Conclusions
Apical right ventriculotomy provides excellent exposure allowing safe and effective closure of apical VSDs. The observed late morbidity and mortality reflects the complexity that often exists in these cases due to additional irreparable lesions. 相似文献19.
D Sh Bagaturiia S N Eralina P D Kalandadze 《Grudnaia i serdechno-sosudistaia khirurgiia / Ministerstvo zdravookhraneniia SSSR [i] Vsesoiuznoe nauchnoe obshchestvo khirurgov》1991,(4):19-22
The methods of bidimensional echocardiography and doppler-echocardiography were used in appraising the condition of the tricuspid valve before and after plastic surgery of ventricular septal defects in 113 patients. Surgical approach through the right atrium was used in plastics of the ventricular septal defect. The patients were examined before the operation and 2 weeks after it; 77 patients were studied in follow-up periods of 6 months to 2 years after the operation. Pansystolic turbulent regurgitation of blood was detected only in 4 patients before plastic repair of the ventricular septal defect. Pansystolic turbulent regurgitation at the tricuspid valve was registered in the immediate postoperative period and 2 weeks after the term periods in many patients and persisted only in 29% of cases. It should be emphasized that tricuspid incompetence was not manifested clinically in these patients. It is concluded that doppler-echocardiography is an effective and highly-sensitive method for the diagnosis of tricuspid incompetence, even if it has no clinical signs. 相似文献