• 临床论丛 • 上一篇    下一篇

二尖瓣置换术后三尖瓣关闭不全的外科治疗体会

李宗虓   

  1. 天津泰达国际心血管病医院
  • 收稿日期:2010-01-27 修回日期:2010-05-09 出版日期:2010-10-15 发布日期:2010-10-15
  • 通讯作者: 李宗虓

Surgical Treatment of Tricuspid Regurgitaion After Mitral Valve Replacement

LI Zong-Xiao   

  • Received:2010-01-27 Revised:2010-05-09 Published:2010-10-15 Online:2010-10-15
  • Contact: LI Zong-Xiao

摘要: [摘要]目的:临床常见曾行二尖瓣置换术、同期或未同期行三尖瓣治疗,远期出现三尖瓣关闭不全加重的病例。本研究拟对上述病例的外科治疗进行相关研究。方法:所有患者皆入院后予改善心功能治疗,病情好转后,择期在全身麻醉下行手术治疗。对不同患者分别采用Kay’s、De Vega法行三尖瓣成形术或瓣膜置换术。结果:术中采用Kay’s法7例(15.6%),De Vega法4例(8.9%),三尖瓣置换术34例(75.6%)。死亡1例(2.2%),44例痊愈出院。术后复查超声心动图,右心房、室均明显缩小,与术前比较差别有统计学意义(P < 0. 05)。结论:对于部分三尖瓣中度关闭不全、三尖瓣瓣环扩大不明显、中度肺动脉高压的患者,可尝试行三尖瓣成形术。但如果术前心功能不全症状、三尖瓣病变均严重,积极应用换瓣治疗会取得较好的效果。

关键词: 三尖瓣关闭不全, 三尖瓣成形术, 三尖瓣置换术

Abstract: Abstract Background: Functional tricuspid regurgitation (TR) can often be observed in patients with rheumatic mitral valve disease, including those who undergo the operation for the first or second time. The aim of this study was to analyze TR in a group of patients who underwent successful mitral valve surgery. Methods and Results: 45 patients with TR after mitral valve replacement were involved in this study. 43 patients (95.6%) had right heart failure symptoms (edema of double lower extremity, ascites, hepatic congestion, etc.). 40 patients (88.9%) had atrial fibrillation. Twenty-six patients (57.8%) were in New York Heart Association (NYHA) functional class III, and 19 (42.9%) in class IV. Prior operations included: 41 for mechanical mitral valve replacement (91.1%), 4 for bioprosthetic mitral valve replacement (8.9%), and 7 for tricuspid annuloplasty (15.6%). All the patients received medicine to improve the heart function. The tricuspid valves were repaired with Kay's (7 cases, 15.6%) or De Vega technique (4 cases, 8.9%). Tricuspid valve replacements were performed in 34 cases (75.6%). 1 patient died (2.2%). Postoperative low cardiac output syndromes (LCOS) were observed in 5 patients and treated effectively. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. Comparing with the preoperative data (33.7±6.2mm), the anteroposterior diameter of right ventricle decreased to 23-41mm (25.5 ±7.1mm) (P<0. 05). Conclusions: If TR occurs or progresses late after valve surgery, annuloplasty or replacement to tricuspid valve may be required and could get a satisfied outcome even if it could carries a high operative risk.

Key words: tricuspid regurgitation, tricuspid annuloplasty, tricuspid valve replacement