经皮三尖瓣置换的应用解剖

Applied anatomy of percutaneous replacement of tricuspid valves

目的:为经皮三尖瓣置换提供相关的应用解剖学基础。方法:解剖测量30例(男20,女10)正常成年人的心标本。体外将双盘状瓣膜支架植入瓣环后,取与支架接触部位的心肌组织切片,HE染色。结果:三尖瓣环形态不甚规则,大致为椭圆形,约3￣4指尖大,整个瓣环不完全在一个平面上,环由致密结缔组织和少量肌组织构成。三尖瓣的长径、短径和瓣口周长分别为(4.30±0.55)、(3.09±0.59)、(11.86±1.37)cm。三尖瓣环与冠状窦口和室上嵴的最短距离分别为(1.12±0.21)cm和(1.79±0.31)cm。双盘状瓣膜支架在三尖瓣环位置良好,对周围结构无影响。HE染色见接触部位心肌组织完整,无损伤或断裂。结论:人工双盘状瓣膜支架的设计大小应根据三尖瓣环的大小及其与周边结构的距离来选择,在自体三尖瓣位置植入双盘状支架可行。

Objective： To understand anatomic characteristics of tricuspid valves of normal adult heart and provide anatomic basis for percutaneous replacement of tricuspid valves. Mothods：30 normal adult heart specimens （2 0 male and 10 female） were dissected and measured. Rosults：The long diameter, short diameter and the perimeter of tricuspid valves were （4.30±0.55）cm,（3.09±0.59 ）cm and （ 11.86±1.37 ）cm respectively. The distance from the tricuspid valves to the coronary sinus and supraventricular crest was （ 1.12±0.21 ）cm and （1.79 ±0.31 ）cm respectively. The tricuspid stent with prosthetic heart valves implanted in tricuspid valve annulus showed suitable position, and which had no influence on adjacent cardiac muscular tissues proved by HE staining. Conclusions： The size of valve stent selected bases on the size of the perimeter of tricuspid valves and the distance from the tricuspid valves to the other structures of the interior of the right heart. It is suggested that percutaneous replacement of tricuspid valves is a feasible method.