右室功能指标对功能性三尖瓣关闭不全患者手术疗效的评估作用

Evaluation of surgical outcomes by right ventricular function parameters in patients with functional tricuspid regurgitation

目的应用右室功能指标对功能性三尖瓣关闭不全(TR)患者经三尖瓣成形术治疗的效果进行评价,分析各项指标的相关性。方法以中度反流以上且接受三尖瓣成形术治疗的功能性TR患者作为研究对象,10例患者接受改良De Vega成形术(缝线成形术组),10例患者接受MC3三维瓣环成形术(人工瓣环成形术组)。分别于手术前后测量和记录患者右室功能指标,包括舒张期三尖瓣瓣环内径(DTV)、心肌做功指数(MPI)、右心室收缩期长轴移位距离(RVLX)、右心室流出道缩短率(RVOTFS)、TR程度指标(STR/SRA)、右房内径(RA)和右室内径(RV)等,对各项指标在手术前后的变化及组间差异进行比较,分析各项指标间的相关性。结果与手术前比较,手术后两组患者STR/SRA、DTV和RA均明显改善。手术后人工瓣环成形术组较缝线成形术组RA的改善更为显著。相关分析表明,手术前后RA与DTV均呈显著正相关(r=0.45,P<0.05;r=0.47,P<0.001);DTV与STR/SRA无明显相关性(P>0.05)。结论对功能性TR患者实施相应的瓣环环缩处理具有重要的临床意义;人工瓣环成形术对RA的改善优于缝线成形术;RA与DTV具有较好的相关性,可作为术前TR程度及手术疗效的评价指标。

Objective To evaluate the clinical outcomes by right ventricular function parameters in patients with functional tricuspid regurgitation(TR) treated with tricuspid annuloplasty,and explore the relationship among the parameters. Methods Patients with functional TR having moderate or more severe regurgitation treated with tricuspid annuloplasty were selected as study objective.Ten patients underwent modified De Vega annuloplasty(suture annuloplasty group),and another 10 patients were managed with MC3 valve ring annuloplasty(artificial valve ring annuloplasty group).The right ventricular function parameters of patients were recorded before and after operation,including diastolic tricuspid annuloplasty diameter(DTV),myocardial performance index(MPI),right ventricular systolic shift from the long axis(RVLX),right ventricular outflow tract shortening(RVOTFS),systolic TR area to right ventricular area(STR/SRA),right atrial diameter(RA) and right ventricular diameter(RV).Parameters before operation and after operation were compared between groups,and the relationship among parameters was explored. Results STR/SRA,DTV and RA in both groups significantly improved after operation.The improvement of RA in artificial valve ring annuloplasty group was more significant than that in suture annuloplasty group.The correlation analysis revealed that RA was positively related to DTV both before operation and after operation(r=0.45,P<0.05;r=0.47,P<0.001),while there was no significant relationship between DTV and STR/SRA(P>0.05). Conclusion Tricuspid annuloplasty for functional TR is of clinical importance.Artificial valve annuloplasty works better than suture annuloplasty in RA improvement.RA is related to DTV,and can serve as an evaluation parameter for TR degree before operation and surgical outcomes.