矫正型大动脉转位形态三尖瓣置换术及中远期结果

目的探讨矫正型大动脉转位（cTGA）患者行形态三尖瓣置换术的手术适应证及其术后中远期结果。方法1997年9月至2007年9月,阜外心血管病医院收治cTGA患者18例,男15例,女3例;年龄16~51岁（33.3±12.8岁）,体重47~90 kg（60.9±14.7 kg）。单纯形态三尖瓣关闭不全10例,合并室间隔缺损3例,合并室间隔缺损及肺动脉瓣狭窄2例,室间隔缺损修补术后形态三尖瓣关闭不全2例,形态三尖瓣置换术后机械瓣功能不良1例。术前形态右心室射血分数为56.2%±11.6%,心功能分级（NYHA）Ⅱ级12例,Ⅲ级6例。18例cTGA患者均施行形态三尖瓣置换术。术后随访患者的心功能、形态右心室射血分数等指标。结果手术死亡1例,死于术后低心排血量综合征。术后发生瓣周漏2例,分别于术后7 d和30 d行瓣周漏修补术后治愈。随访16例,随访时间57.0±40.7个月;随访时形态右心室射血分数与术前比较差异无统计学意义（52.8%±9.2%vs.56.2%±11.6%;t=2.062,P〉0.05）,心功能分级（NYHA）Ⅰ~Ⅱ级12例,Ⅲ级4例,与术前比较心功能分级Ⅲ级者所占百分比差异无统计学意义（χ2=1.532,P〉0.05）。结论cTGA形态三尖瓣置换术能防止形态三尖瓣关闭不全对形态右心室功能的进一步损害;其中远期结果满意;随访期间,形态右心室功能基本正常。

Mid and Long Term Outcomes of the Morphologic Tricuspid Valve Replacement for Patients with Corrected Transposition of the Great Arteries

Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to Septerrlber 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg（60.9±14.7 kg）. There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septaI defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 56.2%±11.6%. Of the 18 cases, 12 were in grade Ⅱand 6 were in grade Ⅲ according to New York Heart classification（NYHA）. All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a follow-up time of 57. 0 ± 40.7 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8 ±9.2 % vs. 56.2 %±11.6%; t = 2. 062, P〉 0.05）. The follow-up showed that 12 were in NYHA grade I or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ （X2=1. 532, P〉 0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long t