Objective To investigate the clinical value of tricuspid valve detachment(TVD)in infants undergoing beating heart surgery for ventricular septal defect(VSD).Methods A total of 589 infants undergoing beating heart surgery for ventricular septal defect were divided into two groups:TVD group(n=158)and non-TVD group(n=431).The extracorporeal circulation time and hospital stay were compared between the two groups.Echocardiography was performed be-fore and 7 days and 1 year after operation to record the incidences of residual leakage and tricuspid regurgitation(TR).Results No death occurred in all patients.Among the 589 patients,392 re-ceived patch repair(including 129 in TVD group and 263 in non-TVD group),and 197 received di-rect suture(including 29 in TVD group and 168 in non-TVD group).Sixty-six infants with de-formity were treated at the same time.No patients had postoperative complete atrioventricular block in TVD group.However,4 patients in non-TVD group had postoperative complete atrioven-tricular block but achieved the restoration of sinus rhythm within 10 days after operation.After follow-up of 1 year,no patients died and received reoperation for TR in both groups.In non-TVDgroup,2 patients underwent reoperation for residual leakage.There were no significant differences in extracorporeal circulation time and hospital stay between the two groups(P >0.05).Compared with non-TVD group,the incidence of postoperative residual leakage and incidence of TR 7 days and 1 year after operation significantly decreased in TVD group(P <0.05).Conclusion TVD is safe and effective for improving the VSD exposure,reducing the incidence of residual leakage,pro-tecting the structure of tricuspid valve leaflets and decreasing the occurrence of serious postopera-tive TR in infants undergoing beating heart surgery for VSD.%目的：探讨三尖瓣适当切开（TVD）技术在婴幼儿心脏不停跳室间隔缺损（VSD）修补手术中的应用价值。方法将589例行心脏不停跳 VSD 修补术的婴幼儿按是否采用 TVD 技术分为2组：TVD 组158例采用 TVD 技术，非 TVD 组431例未采用 TVD 技术。比较2组体外循环（TEE）时间、住院时间，在术前与术后7 d、1年行心脏彩超检查，记录术后残余漏发生率，术后7 d、1年三尖瓣反流（TR）发生率。结果围手术期无死亡病例。392例进行补片修补，其中 TVD 组129例，非 TVD 组263例；197例直接缝合，其中 TVD 组29例，非 TVD 组168例。66例合并畸形患儿同期进行矫治。术后并发完全性房室传导阻滞：TVD 组0例，非 TVD 组4例，均于术后10 d 内恢复窦性。随访1年，2组病例均无远期死亡，均无因 TR 再手术，非 TVD 组2例因残余漏再手术。2组 TEE 时间、住院时间比较差异无统计学意义（P ＞0．05）；TVD 组术后残余漏及术后7 d、1年 TR 发生率均较非 TVD 组显著减少（P ＜0．05）。结论在婴幼儿心脏不停跳室间隔缺损修补术中，应用 TVD 技术安全、有效，能改善 VSD 的暴露，减少残余漏发生，保护三尖瓣瓣叶结构，减少术后严重 TR 的发生。
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