心脏瓣膜替换术后远期三尖瓣关闭不全的治疗体会

Experience of treatment of late functional tricuspid regurgitation after left cardiac valve replacement

目的报告左心瓣置换术后远期三尖瓣关闭不全(TR)的治疗体会。方法21例左心瓣置换术后中重度TR病人,有9例行内科保守治疗,12例行外科手术治疗。手术类型:二尖瓣再次置换加三尖瓣置换术1例,主动脉瓣置换加三尖瓣成形术1例,单纯三尖瓣置换1例,单纯三尖瓣成形术9例。三尖瓣成形术包括5例改良Devega成形术,行改良Key氏法4例。结果12例手术治疗者术后早期1例,病死率8.3%。长期生存11例,术后随访5个月-9.6年,平均6.1年,1例术后三年死于抗凝过度出血。9例内科治疗者,3个月-5年,6例死亡。病死率66.7%。结论左心瓣置换术后远期TR的产生与不可逆的右心损害、严重肺动脉高压、持续的心房纤颤及左心功能的恢复情况有关;对重度TR行三尖瓣成形或三尖瓣置换术可取得良好的效果。

Objective To investigate the role of treatment of the late tricuspid valve regurgitation after left cardiac valve replacement. Methods twenty-one patients with moderate to sever functional TR after left cardiac valve replacement. 9 patients received medical therapy, and 12 surgical treatment, The types of surgery included MVR and tricuspid valve replacement in 1, AVR and tricuspid valve annuloplasty in 1, tricuspid valve replacement in 1 and tricuspid valve annuloplasty in 9. Different methods of tricuspid valve annulop1asty were used for correction of TR, including modified De Vega annuloplasty in 5 and modified Key annuloplasty in 4. Results Six patients received medical therapy died within 3 months to 5 years and the mortality rate was 66.7%. One patient died postoperatively with hospital motality of 8.3%. The 11 survivors were followed up form 5 months to 9.6 years and there was one late death. Conclusion The irreversible right heart impairment, sustained pulmonary hypertension, sustained atrial fibrillation and resumption of left ventricular function may be responsible for the development of late functional TR after left cardiac valve replacement. The surgical management of the TR, including tricuspid valve replacement and tricuspid valve annuloplastv may achieve excellent results.