室间隔缺损封堵术并发三尖瓣反流的原因分析

目的探讨经导管膜部室间隔缺损（membranous ventricular septal defect，mVSD）封堵术并发三尖瓣反流的可能原因及注意问题。方法对542例成功行mVSD封堵术患者术前、术后即刻行超声心动图检测，术后5d，1、3、6、12个月随访。结果术后14例出现三尖瓣反流，其中11例术后即刻及3d出现少量反流。22例术前超声心动图显示三尖瓣前叶腱索附着异常中3例最短术后4d、最长1个月发现三尖瓣前叶腱索断裂，出现中量反流。三尖瓣隔叶、腱索和（或）缺损周缘增生的组织粘连融合，形成缺损口右室侧多孔及不同形态，其中7例呈较大的囊袋样不规则形或瘤形，缺损口周缘部分由三尖瓣隔叶和（或）腱索构成。结论mVSD封堵并发三尖瓣反流的原因可能为导管损伤腱索、输送杆损伤腱索和封堵器磨损腱索。术前选择适应证时，除常规观察项目外，还应注意观察三尖瓣前叶腱索位置、缺损周缘构成的组织结构及缺损口右室侧形态，以减少并发症。

Analysis of tricuspid regurgitation complication caused by membranous ventricular septal defect occlusion

Objective To probe into the possible reason of tricuspid regurgitation(TR) caused by membranous ventricular septal defect(mVSD) occlusion.Methods Five hundred and forty-two patients with successfully occluded mVSD were examined by echocardiography before and at the moment after occlusion,and follow-up of 5 d,1 month,3 month,6 month and 12 month post-operation were performed.Results TR was visualized in 14 cases after occlusion by echocardiography,a small quantity of regurgitation was visualized at the moment and 3 d after occlusion in 11 cases.Before operation attached abnormally anterior tricuspid leaflets and chordae tendineas were detected by echocardiography in 22 patients,in which 3 cases showed tricuspid valve(TV) ruptures with moderate TR in the shortest time of(4 d),longest time of 1 month after operation.Septal leaflet of TV and chordae tendineas were conglutinated and amalgamated with fibrous tissue hyperplasia of defect margin,which led to multi-holes and different shapes of defect on the right ventricular side.In them,7 cases had defects featured as irregular big baggy shapes or aneurysm shapes.Partial defect margins were composed of septal tricuspid leaflet and(or) chordae tendineas.Conclusions The causes of subsequent TR after mVSD occlusion may be the chordae tendineas injury by catheter,guiding stick and occluder.In the screening patients before operation,visualizing sites of anterior tricuspid leaflet and chordae tendineas must be emphasized,including tissue structure of defect margin and defect shape of right ventricular side except routine detections.