摘要
目的探讨膜周部室间隔缺损（VSD）介入术后随访过程中新发现的三尖瓣损伤病例特点，以期发现其中规律。方法回顾性分析2003年3月至2015年4月南京医科大学附属南京儿童医院成功完成膜部VSD介入治疗，随访过程中发现三尖瓣严重损伤11例患儿的临床资料。结果11例患儿中10例再次接受外科手术：7例并假性膨出瘤患儿封堵器过多偏向右心室，三尖瓣腱索和／或瓣叶被右心室盘缠绕、挤压、磨损导致关闭不全，其中1例为瓣叶融合处撕裂致三尖瓣关闭不全；3例不合并假性膨出瘤患儿呈纺锤样凸人右心室的右心室盘恢复盘样结构并挤压三尖瓣腱索或瓣叶，右心室盘螺母缠绕三尖瓣腱索导致关闭不全。外科术后随访存在少量三尖瓣反流，心脏大小及心功能正常。1例患儿未接受外科手术，目前随访右心房及右心室明显扩大，活动能力轻微受限。结论膜周部VSD介入治疗术后新发现的三尖瓣损伤多见于合并假性膨出瘤，且瘤体较大以及出现封堵器右心室盘成形不良的患儿，选择封堵器型号及操作中应充分考虑这些因素。对于膜周部VSD介入治疗术后应建立长期随访机制。
Objective To investigate the characteristics of the newly discovered tricuspid injury during the fol- low - up of the patients with interventional transcatheter closure for perimembranous ventricular septal defect （VSD）. Methods A retrospective analysis of clinical data was performed in the successful completion of membranous VSD in- tervention from March 2003 to April 2015, and 11 cases of serious tricuspid injury in children were found during the fol- low - up. Results Among 11 children, 10 cases underwent surgery again, and in 7 cases of them with pseudoaneurysm of perimemhranous septum, the occluders were deviated toward the right ventricul which caused valvular inadequacy for plate winding closures, extrusion and wear of tricuspid chordae and/or leaflet by right ventricul （ RV ） disc. Among them, 1 case was caused by leaflet fusion tear and tricuspid valve insufficiency;3 cases without pseudoaneurysm were caused by a spindle like RV disc recovery structure protruding into the right ventricle, and then the disc squeezed the tricuspid tendinous cord or leaflet and the right ventrieular disc nut wrapped tendon of tricuspid valve finally leading to tricuspid valve insufficiency. There was a small amount of tricuspid regurgitation after surgery; the cardiac size and car- diac function returned to normal. One case did not receive surgery, and at present the right atrium and right ventricle were significantly enlarged, and the activity was limited. Conclusions Tricuspid injury discovered newly after perimem- branous VSD interventional therapy is more common in pseudoaneurysm with large tumor occluding the right ventricnlar disc resulting in poor formation ,and it is important to consider these factors in choosing the size of the occluder and the operation. Long term follow - up mechanism should be established for the treatment of VSD after interventional therapy.
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2016年第13期997-1000,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
南京市医学科技发展项目（YKK13136）
关键词
膜周部室间隔缺损
介入治疗
三尖瓣损伤
随访
Perimembranous ventricular septal defect
Interventional transcatheter closure
Tricuspid injury
Follow - up
