改良Carpentier法治疗三尖瓣下移畸形32例病例分析
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摘要
目的:总结32例Ebstein畸形经改良Carpentier法手术治疗的疗效与经验。方法:回顾性分析自2003年6月至2013年8月采取改良Carpentier法手术治疗的32例Ebstein畸形(儿童23例,成人9例)的临床资料,其中男性15例,女性17例;年龄1~60岁,体质量8.5~68 kg。手术方式为改良Carpentier法,先将所有有用瓣叶切下,纵向折叠房化右心室,将瓣叶顺时针转位缝合至新瓣环根部,同期矫治合并畸形。其中6例因右心室发育差,三尖瓣瓣环小,加行双向格林术。结果:1例患儿因术后早期心律失常并发持续性低氧血症而死亡,余均存活,顺利出院。其中1例术后出现Ⅲ°房室传导阻滞,3个月后回转窦性心律。存活31例均获随访,随访时间1~72个月,其中术后复查超声心动三尖瓣反流情况轻度21例,轻中度5例,中度5例,重度1例。结论:运用改良Carpentier法手术治疗Ebstein畸形,较好保留了右心室形态,三尖瓣整形好,术后心功能恢复良好,效果满意。
Objective:To evaluate the eficacy of surgical treatment of Ebstein's anomaly with modified Carpentier's repair technique.Methods:From Jun.2003 to Aug.2013,We analyzed 32 patients(23 child and 9 adult) received corrective surgery for Ebstein's anomaly with modified Carpentier's repair technique:including 15 males and 17 females,aged from 1 year to 60 years and the weight was from 8.5-68 kg.On the basis of Carpentier'S technique,the edge of posterior leaflet was sewed to the edge of anterior leaflet or septal leaflet in favor of enlarging the area of leaflet.Associated heart lesions were corrected at the same time.6 patients were added bidirectional Glenn operation.Results:There were one patient died of hypoxemia and arrhythmia.Complete heart block developed in one patient.Survivors were followed up for 1-72 months.No late death occurred.Conclusion:In the Treatment of Ebstein's Anomaly,The modified Carpentier's repair technique that preserving the apex-to-base dimension of the right entricle,is feasible.
Objective:To evaluate the eficacy of surgical treatment of Ebstein's anomaly with modified Carpentier's repair technique.Methods:From Jun.2003 to Aug.2013,We analyzed 32 patients(23 child and 9 adult) received corrective surgery for Ebstein's anomaly with modified Carpentier's repair technique:including 15 males and 17 females,aged from 1 year to 60 years and the weight was from 8.5-68 kg.On the basis of Carpentier'S technique,the edge of posterior leaflet was sewed to the edge of anterior leaflet or septal leaflet in favor of enlarging the area of leaflet.Associated heart lesions were corrected at the same time.6 patients were added bidirectional Glenn operation.Results:There were one patient died of hypoxemia and arrhythmia.Complete heart block developed in one patient.Survivors were followed up for 1-72 months.No late death occurred.Conclusion:In the Treatment of Ebstein's Anomaly,The modified Carpentier's repair technique that preserving the apex-to-base dimension of the right entricle,is feasible.
引文
[1]刘迎龙.Ebstein心脏畸形//朱晓东,张宝仁.心脏外科学.北京:人民卫生出版社,2007:457-462.
[2]Mann RJ,Lie JT.The life story of Wilhelm Ebstein(1836-1912)and his almost overlooked description of a congenital heart disease.Mayo Clin Proc,1979,54:197.
[3]Celermajer DS,Bull C,Till JA,et al.Ebstein’s anomaly:presentation and outcome from fetus to adule.Am Coll Cardiol,1994,23:170.
[4]吴清玉,张怀军,许建屏.108例三尖瓣下移的矫治.中华外科杂志,1999,37:663-665.
[5]Hunter SW,Lillehei CW.Ebstein’s malformation of the tricuspid valve;study of a case together with suggestion of a new form of surgical therpy.Dis Chest,1958,33:297.
[6]Hardy KL,Mary IA,Webster CA,et al.Ebstein’s anomaly:a functional concept and successful definitive repair.J Thorac Cardiovasc Surg,1964,48:927.
[7]Danielson GK,Driscoll DJ,Mair DD,et al.Operation treatment of Ebstein anomaly.Thorac Cardiovasc Surg,1992,104:1195-1202.
[8]Carpentier A,Chauvaud S,Mace L,et al.A new reconstructive operation for Ehstein's anomaly of the tricuspid valve.Thorac Cardiovase Surg,1988,96:92-101.
[9]杜亮,郭兰敏.Ebstein畸形中三尖瓣的解剖特征及其临床意义.中国临床解剖学杂志,2000,18:121-123.
[10]许建平,高峰,吴清玉.三尖瓣下移畸形的外科治疗.中华胸心血管外科杂志,2005,21:368-369.
[11]褚衍林,吴英渝,李鲁,等.三尖瓣下移畸形的诊断及外科治疗.心肺血管病杂志,2004,23:160-161.
[12]Marianeschi SM,McElhinney DB,Ready VM,et al.Alternative approach to the repair of ebstein rs malformation:intracardiac repair with ventricular unloading.Ann Thorac Surg,1998,66:1546-1550.
[2]Mann RJ,Lie JT.The life story of Wilhelm Ebstein(1836-1912)and his almost overlooked description of a congenital heart disease.Mayo Clin Proc,1979,54:197.
[3]Celermajer DS,Bull C,Till JA,et al.Ebstein’s anomaly:presentation and outcome from fetus to adule.Am Coll Cardiol,1994,23:170.
[4]吴清玉,张怀军,许建屏.108例三尖瓣下移的矫治.中华外科杂志,1999,37:663-665.
[5]Hunter SW,Lillehei CW.Ebstein’s malformation of the tricuspid valve;study of a case together with suggestion of a new form of surgical therpy.Dis Chest,1958,33:297.
[6]Hardy KL,Mary IA,Webster CA,et al.Ebstein’s anomaly:a functional concept and successful definitive repair.J Thorac Cardiovasc Surg,1964,48:927.
[7]Danielson GK,Driscoll DJ,Mair DD,et al.Operation treatment of Ebstein anomaly.Thorac Cardiovasc Surg,1992,104:1195-1202.
[8]Carpentier A,Chauvaud S,Mace L,et al.A new reconstructive operation for Ehstein's anomaly of the tricuspid valve.Thorac Cardiovase Surg,1988,96:92-101.
[9]杜亮,郭兰敏.Ebstein畸形中三尖瓣的解剖特征及其临床意义.中国临床解剖学杂志,2000,18:121-123.
[10]许建平,高峰,吴清玉.三尖瓣下移畸形的外科治疗.中华胸心血管外科杂志,2005,21:368-369.
[11]褚衍林,吴英渝,李鲁,等.三尖瓣下移畸形的诊断及外科治疗.心肺血管病杂志,2004,23:160-161.
[12]Marianeschi SM,McElhinney DB,Ready VM,et al.Alternative approach to the repair of ebstein rs malformation:intracardiac repair with ventricular unloading.Ann Thorac Surg,1998,66:1546-1550.