膜周部室间隔缺损合并三尖瓣反流的机制探讨

目的通过术前、术后超声心动图和彩色多普勒检查及手术所见,评价及明确膜周部室间隔缺损合并三尖瓣反流的机制.方法通过13例膜周部室间隔缺损合并三尖瓣反流的临床资料,经胸超声心动图术前诊断及术后复查,结合术中所见,观察膜周部室间隔缺损和三尖瓣反流的关系.结果所有病例均为中等膜周部室间隔缺损,中等量的左向右分流,心室收缩期,二维超声心动图可见典型的三尖瓣前向运动及三尖瓣呈开放状态.彩色多普勒血流显象,大多数病例表现为经室缺的部分穿隔血流被隔瓣阻挡,但主要血流经三尖瓣隔瓣下缘穿过,冲击到三尖瓣的前瓣,导致三尖瓣反流.室缺修补后,三尖瓣反流消失.结论膜周室缺的穿隔血流可导致膜周室缺合并三尖瓣反流.二维超声心动图及彩色多普勒血流显象发现该现象,这是外科手术修补室缺的良好指征.

Mechanism of tricuspid regurgitation in paramembranous ventricular septal defect

Objective To describe our echocardiographic and intraoperative findings, which suggest another mechanism for tricuspid regurgitation (TR) in patients with paramembranouse ventricular septal defect (VSD). Methods We evaluated 13 patients with moderate paramembranouse VSD ad TR. All patients were identified by preoperative transthoracic echocardiography. Routine standard transthoracic 2 dimensional echocardiography was performed after surgery. Results Moderate sized paramembranouse VSD with moderate amount of left-to-right shunt were found on color Doppler imaging in all cases. Systolic anterior movement of the tricuspid anterior leaflet with opening of the tricuspid valve orifice were typical characters of these patients. The tricuspid septal leaflet, below which major VSD shunt coursed, partially obstructed the superior portion of the VSD. Conclusion Shunt of paramembranouse VSD can jet to force the anterior tricuspid leaflet away from the septal leaflet with resultant significant TR. Combination of paramembranous VSD and significant TR identified by echocardiography should be considered an indication for surgical closure of VSD.