风心瓣膜替换术后远期三尖瓣关闭不全的原因分析及治疗对策

Causal Analysis of Late Tricuspid Regurgitation after Valvular Replacement due to Rheumatic Heart Disease and Its Therapeutic Approaches

目的探讨左心瓣膜置换术后远期三尖瓣膜关闭不全（TR）的发生原因及治疗方法。方法6例左心瓣膜置换术后中、重度TR病人，3例行再手术治疗，3例非手术治疗。手术治疗均为Devega成形术。结果手术治疗后的3例恢复良好，随访1～7年，心功能进步为Ⅰ-Ⅱ级。非手术治疗的3例，死亡2例，1例心功能Ⅲ-Ⅳ级。结论第1次手术对TR处理的方法技巧、对轻度TR处理与否的认识问题及对术后心功能的支持等相关措施，与左心瓣膜替换术后远期三尖瓣关闭不全呈明显的相关。对术后出现的中、重度TR应积极行再手术治疗，可取得良好效果。

Objective To explore the causes of late functional tricuspid regurgitation （TR） after left cardiac valvular replacement, as well as its therapeutic approaches. Methods Six patients with moderate or severe TR after left cardiac valvular replacement due to rheumatic heart disease were treated with re-operation （ Devega＇ s plasty） in three ones and with conservative approach in the other three ones. Results According to seven years＇ follow-up, the three ones who were performed re-operation obtained satisfactory recovery （ heart functions were upgraded to grade Ⅰ - Ⅱ ）, whereas the conditions of the other three ones treated with non-operative approache deteriorated （ i. e. two ones died and the heart function of the one left was downgraded to grade Ⅲ or Ⅳ ）. Conclusion Surgical operation is effective on late functional TR after left cardiac valvular replacement due to rheumatic heart disease.