风湿性心脏病器质性三尖瓣病变的外科治疗

Surgery for Rheumatic Tricuspid Valve Disease

报告１９８７年５月～１９９５年６月手术治疗风心病器质性三尖瓣病变４２例。３１例施行瓣膜成形术，１１例施行瓣膜置换术。手术死亡１例，远期随诊３８例，２例远期死亡。成形者远期复诊２５例，６例仍有右心衰或超声心动图检测三尖瓣返流在中度以上。三尖瓣置换者远期无右心衰表现，人工瓣功能良好。作者认为多数器质性三尖瓣病变可用成形术矫治，但如瓣叶明显增厚、变形及成形不满意者应积极行瓣膜置换。

From May 1987 to June 1995, 42 patients with rheumatic tricuspid valve lesion were operated on. The lesions were simple stenosis in 4 patients, stenosis and regurgitation 34 and simple regurgitation 5. Thirty-one of them underwent valvuloplasty and 11 underwent valve replacement. The associated procedures included MVR in 19, mitral valvuloplasty in 1,DVR in 21 and AVR in 1.There was one hospital death. Thirty eight of the early survivals were followed up from 4 to 76 months (mean 37 months). Late deaths occured in 2 cases and heart functional classⅠ was in 16, class Ⅱ in 16, class Ⅲ in 3, class Ⅳ in 1.Echocardiography performed in 20 cases after valvuloplasty which showed no regurgitation in 6,mild regurgitation in 11,morderate regurgitation in 5,severe regurgitation in 1,and mild stenosis in 2.The principles and operative technique of tricuspid valve repair and replacement are detailed.