Application Value of Modified Tricuspid Valvuloplasty Using Anterior Leaflet in Surgery of Partial Antrioventricular Septal Defect_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUANGJian-bing , JIANGZhao-lei , DINGFang-bao , LIUHao , WUShu-bin ,  MEIJu

Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P. R. China;

Corresponding author：

MEIJu, Email: jb4480@163.com

Keywords：

Tricuspid regurgitation; Tricuspid septal leaflet dysplasia; Anterior leaflet; Partial antrioventricular septal defect

DOI：

10.7507/1007-4848.20150241

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Objective To investigate the therapeutic effect of modified tricuspid valvuloplasty using anterior leaflet in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia. Methods Ninety-five patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia underwent surgical treatment in our hospital from June 2002 to March 2014. There were 39 males and 56 females with an average age of 3.2±6.6 years (range 3 months to 46 years). Preoperative echocardiography prompted all patients had varying degrees of tricuspid valve dysplasia and tricuspid regurgitation (mild in 14 cases, moderate in 49 cases, and severe in 32 cases). According to the different development of anterior and septal leaflet, we used different techniques to repair the tricuspid problems. If the residual septal leaflet was larger than one third of the normal septal leaflet, we continuously stitched the half of the septal side of anterior leaflet to the two third of the left side of residual septal leaflet. If the residual septal leaflet was less than one third of the normal septal leaflet, we reserved part of pericardial patch at right side of septal crest at repairing the atrial septal defect, and continuously stitched the left two third of the patch edge to the half of septal side of anterior leaflet. All patients received transesophageal echocardiography (TEE) to evaluate the intraoperative effect of valvuloplasty. The patients were followed up with echocardiography after 3 to 6 months to evaluate the condition of tricuspid. Results There was no perioperative death or Ⅲ degree atrioventricular block. Intraoperative TEE showed that the effect of tricuspid valvuloplasty was good with 3 cases of mild regurgitation and 2 cases of moderate regurgitation. Other 90 cases had no significant regurgitation. The aortic cross-clamping time was 35.2±11.2 min and cardiopulmonary bypass time was 64.9±16.6 min. In the followed-up between 3 to 6 months, tricuspid regurgitation situation improved significantly than that in preoperative period with mild regurgitation or no reflux in 89 cases and moderate regurgitation in 6 cases. There was no severe regurgitation occurred. Conclusion The therapeutic effect is satisfactory by using anterior leaflet to repair the regurgitation of tricuspid in patients with partial antrioventricular septal defect and tricuspid septal leaflet dysplasia.

Citation： HUANGJian-bing, JIANGZhao-lei, DINGFang-bao, LIUHao, WUShu-bin, MEIJu. Application Value of Modified Tricuspid Valvuloplasty Using Anterior Leaflet in Surgery of Partial Antrioventricular Septal Defect. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(10): 972-975. doi: 10.7507/1007-4848.20150241 Copy

1.	刘浪,陈凯明,赖锋华,等.房室间隔缺损的外科治疗.中国煤炭工业医学杂志,2014,17(8):1228-1231.
2.	Bowman JL,Dearani JA,Burkhart HM,et al.Should repair of partial atrioventricular septal defect be delayed until later in childhood?Am J Cardiol,2014,114(3):463-467.
3.	Jacobs JP,Jacobs ML,Mavroudis C,et al.Atrioventricular septal defects:lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the society of thoracic surgeons.World J Pediatr Congenit Heart Surg,2010,1(1):68-77.
4.	Talwar S,Singh V,Chandra N,et al.Challenges in delayed repair of atrioventricular septal defects.World J Pediatr Congenit Heart Surg,2010,1(1):87-90.
5.	Beaton AZ,Pike JI,Stallinqs C,et al.Predictors of repair and outcome in prenatally diagnosed atrioventricular septal defects.J Am Soc Echocardiogr,2013,26(2):208-216.
6.	刘迎龙.先天性心脏瓣膜疾病的成形手术.心肺血管病杂志,2013,32(6):663-665.
7.	Hoohenkerk GJ,Bruggemans EF,Rijlaarsdam M,et al.More than.
8.	years'experience with surgical correction of atrioventricular septal defects.Ann Thorac Surg,2010,90(5):1554-1561.
9.	Minich LL,Atz AM,Colan SD,et al.Partial and transitional atrioventricular septal defect outcomes.Ann Thorac Surg,2010,89(2):530-536.
10.	吴慧颖,杨桂林,许日昊,等.三尖瓣隔瓣重建术在心内膜垫缺损矫治术中的应用.中国妇幼保健,2011,26(6):932-934.
11.	Said SM,Burkhart HM,Dearani JA.Surgical management of congenital(non-Ebstein)tricuspid valve regurgitation.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2012,15(1):46-60.
12.	任卫东,陆恩祥,主编.心脏超声诊断图谱.沈阳:辽宁科学技术出版社,1998.29-30.
13.	刘迎龙,于存涛,沈向东,等.婴幼儿完全性心内膜垫缺损的外科治疗.中华胸心血管外科杂志,2005,41(6):365-366.
14.	Shuhaiber JH,Ho SY,Rigby M,Sethia B.et al.Current options and outcomes for the management of atrioventricular septal defect.Eur J Cardiothorac Surg,2009,35(5):891-900.
15.	Kogon BE,Butler H,McConnell M,et al.What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice?Cardiol Young,2007,17(4):356-359.
16.	Jerbi S,Tarmiz A,Romdhani N et al.Surgery of 56 patients having a partial atrioventricular septal defect.Ann Cardiol Angeiol(Paris),2009,58(2):129-133.
17.	El-Najdawi EK,Driscoll DJ,Puga FJ,et al.Operation for partial atrioventricular septal defect:a forty-year review.J Thorac Cardiovasc Surg,2000,119(5):880-889.
18.	Permut LC,Mehta V.Late results and reoperation after repair of complete and partial atrioventricular canal defect.Semin Thorac Cardiovasc Surg,1997,9(1):44-54.
19.	Alexi-Meskishvili V,Hetzer R,Dähnert I,et al.Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects.Eur J Cardiothorac Surg,1997,12(3):460-465.
20.	De Bonis M,Taramasso M,Lapenna E,et al.Management of tricuspid regurgitation.F1000Prime Rep,2014,6:58.
21.	Bonello B,Kilner PJ.Review of the role of cardiovascular magnetic resonance in congenital heart disease,with a focus on right ventricle assessment.Arch Cardiovas Dis,2012,105(11):605-613.

1. 刘浪,陈凯明,赖锋华,等.房室间隔缺损的外科治疗.中国煤炭工业医学杂志,2014,17(8):1228-1231.
2. Bowman JL,Dearani JA,Burkhart HM,et al.Should repair of partial atrioventricular septal defect be delayed until later in childhood?Am J Cardiol,2014,114(3):463-467.
3. Jacobs JP,Jacobs ML,Mavroudis C,et al.Atrioventricular septal defects:lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the society of thoracic surgeons.World J Pediatr Congenit Heart Surg,2010,1(1):68-77.
4. Talwar S,Singh V,Chandra N,et al.Challenges in delayed repair of atrioventricular septal defects.World J Pediatr Congenit Heart Surg,2010,1(1):87-90.
5. Beaton AZ,Pike JI,Stallinqs C,et al.Predictors of repair and outcome in prenatally diagnosed atrioventricular septal defects.J Am Soc Echocardiogr,2013,26(2):208-216.
6. 刘迎龙.先天性心脏瓣膜疾病的成形手术.心肺血管病杂志,2013,32(6):663-665.
7. Hoohenkerk GJ,Bruggemans EF,Rijlaarsdam M,et al.More than.
8. years'experience with surgical correction of atrioventricular septal defects.Ann Thorac Surg,2010,90(5):1554-1561.
9. Minich LL,Atz AM,Colan SD,et al.Partial and transitional atrioventricular septal defect outcomes.Ann Thorac Surg,2010,89(2):530-536.
10. 吴慧颖,杨桂林,许日昊,等.三尖瓣隔瓣重建术在心内膜垫缺损矫治术中的应用.中国妇幼保健,2011,26(6):932-934.
11. Said SM,Burkhart HM,Dearani JA.Surgical management of congenital(non-Ebstein)tricuspid valve regurgitation.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu,2012,15(1):46-60.
12. 任卫东,陆恩祥,主编.心脏超声诊断图谱.沈阳:辽宁科学技术出版社,1998.29-30.
13. 刘迎龙,于存涛,沈向东,等.婴幼儿完全性心内膜垫缺损的外科治疗.中华胸心血管外科杂志,2005,41(6):365-366.
14. Shuhaiber JH,Ho SY,Rigby M,Sethia B.et al.Current options and outcomes for the management of atrioventricular septal defect.Eur J Cardiothorac Surg,2009,35(5):891-900.
15. Kogon BE,Butler H,McConnell M,et al.What is the optimal time to repair atrioventricular septal defect and common atrioventricular valvar orifice?Cardiol Young,2007,17(4):356-359.
16. Jerbi S,Tarmiz A,Romdhani N et al.Surgery of 56 patients having a partial atrioventricular septal defect.Ann Cardiol Angeiol(Paris),2009,58(2):129-133.
17. El-Najdawi EK,Driscoll DJ,Puga FJ,et al.Operation for partial atrioventricular septal defect:a forty-year review.J Thorac Cardiovasc Surg,2000,119(5):880-889.
18. Permut LC,Mehta V.Late results and reoperation after repair of complete and partial atrioventricular canal defect.Semin Thorac Cardiovasc Surg,1997,9(1):44-54.
19. Alexi-Meskishvili V,Hetzer R,Dähnert I,et al.Results of left atrioventricular valve reconstruction after previous correction of atrioventricular septal defects.Eur J Cardiothorac Surg,1997,12(3):460-465.
20. De Bonis M,Taramasso M,Lapenna E,et al.Management of tricuspid regurgitation.F1000Prime Rep,2014,6:58.
21. Bonello B,Kilner PJ.Review of the role of cardiovascular magnetic resonance in congenital heart disease,with a focus on right ventricle assessment.Arch Cardiovas Dis,2012,105(11):605-613.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application Value of Modified Tricuspid Valvuloplasty Using Anterior Leaflet in Surgery of Partial Antrioventricular Septal Defect

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