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目的分析经导管膜周部室间隔缺损(PMVSDs)封堵术并发三尖瓣损伤原因,探讨其预防及处理措施。方法 2002年10月至2009年12月广东省心血管病研究所825例PMVSDs患儿,均进行了经导管介入封堵,其中8例出现三尖瓣损伤。8例患儿中男4例,女4例;年龄3.5～8.0岁。8例三尖瓣损伤患儿中4例出现三尖瓣狭窄,其中2例严重狭窄者行外科手术治疗,术中见封堵器右室盘与三尖瓣腱索缠绕,予松开缠绕、取出封堵器并修补室间隔缺损;2例轻度狭窄者予随诊观察。8例中其余4例出现三尖瓣关闭不全,其中3例反流严重予外科手术治疗,术中见三尖瓣腱索断裂1例,腱索断裂并瓣膜撕裂1例,三尖瓣隔瓣腱索被封堵器牵拉1例。术中将断裂的腱索缝合,取出封堵器并修补室缺,合并三尖瓣撕裂者行三尖瓣整形。余1例三尖瓣隔瓣脱垂并轻至中度反流的病例予随诊。结果 5例外科手术治疗者中,4例三尖瓣功能恢复良好,1例三尖瓣血流速度稍增快。三尖瓣损伤不重未行外科处理的3例病例随诊1月至2年,三尖瓣病变无加重,患儿无明显临床症状。结论经导管PMVSDS封堵术并发三尖瓣损伤有多方面原因。操作中应避免轨道钢丝穿过三尖瓣腱索,出现腱索与封堵器或输送钢缆缠绕时切勿使用暴力牵拉。三尖瓣损伤严重时应外科手术治疗。
Objective To analyze the causes of tricuspid valve trauma complicated with transcatheter closure of perimembranous ventricular septal defects (PMVSDs) and to discuss the preventive measures. Methods From October 2002 to December 2009, 825 children with PMVSDs in Guangdong Institute of Cardiovascular Diseases were treated with catheterization and occlusion, of which 8 cases had tricuspid valve injury. 8 cases of children in 4 males and 4 females; aged 3.5 to 8.0 years. Tricuspid stenosis was found in 4 of 8 children with tricuspid valve injury. Among them, 2 patients with severe stenosis were treated by surgery. In the operation, the occluder right ventricle disk and tricuspid tendon were wound, Remove occluder and repair ventricular septal defect; 2 cases of mild stenosis were followed up. In the remaining 4 cases, tricuspid regurgitation occurred in 4 of 8 cases. Among them, 3 cases were treated with severe regurgitation by surgical operation. One case of tricuspid chordae rupture, 1 case of rupture of tendon and 1 case of valve rupture, Achilles tendon was pulled by an occluder in 1 case. The operation will be broken tendon suture, remove the occluder and repair of ventricular aneurysm, tricuspid valve torn with tricuspid valve surgery. More than 1 cases of tricuspid valve flap prolapse and mild to moderate reflux cases were followed up. Results Among the 5 surgical patients, the tricuspid valve function recovered well in 4 cases, and the tricuspid flow velocity increased slightly in 1 case. Tricuspid valve injury is not serious Surgical treatment of 3 cases followed up for 1 month to 2 years, tricuspid disease without aggravating, children with no obvious clinical symptoms. Conclusions Transcatheter closure of PMVSDS complicated by tricuspid valve injury has many reasons. Operation should be avoided through the tricuspid wire tendons tendons, tendons and occluders appear or when the delivery cable does not use violence to pull. Severe tricuspid valve surgery should be surgical treatment.