功能性三尖瓣关闭不全的分析和治疗

Clinical analysis and treatment for “functional” tricuspid valve regurgitation

目的为提高治疗功能性三尖瓣关闭不全（ＴＲ）水平，总结近５年临床体会。方法分析３５例经手术治疗ＴＲ患者，其中瓣膜病组２６例，先心病组９例。瓣膜病组与同期７９例患者资料比较，手术行三尖瓣环成形术。结果瓣膜病组ＴＲ发生率为５５２％，其与病程、心胸比值、ＥＦ、左房大小有关（Ｐ＜０．０５），其中８２８％为心房颤动（Ｐ均＜０．０１），重度肺高压６７２％（Ｐ＜０．０５）。先心病组中左向右分流患者均为重度肺动脉高压，有紫绀患者均有右心扩大。随访２４例，心功能Ⅰ级１７例、Ⅱ级６例、Ⅲ级１例。结论三尖瓣环成形术是治疗ＴＲ有效方法，应根据临床表现、右心功能、肺血管阻力及ＴＲ程度决定手术指征。

Objective Our five year experience in surgical treatment of “functional” tricuspid valve regurgitation (TR) was summarized for the purpose of improving the treatment.Methods Thirty five patients were analyzed. There were 26 patients in the valve group and nine in the congenital heart disease (CHD) group. Cohn′s annuloplasty was performed in all patients. Patients in the valve group were compared with 79 patients who received valve replacement in the same period.Results The incidence of TR was 55.2% (58/105) in the valve group. TR was associated with the course of the disease, C/T, EF and LA size ( P <0.05). In the TR group 82.5% patients showed atrial fibrillation rhythm ( P <0.01) and 67.2% pulmonary hypertension ( P <0.05). In the patients with noncyanotic CHD, the pulmonary resistance was 125 230 kPa·S -1 ·L -1 . In four cyanotic patients the right atrium or ventricle was markedly dilated. Twenty four patients were followed for 2 66 months (mean of 25.4 months). Five patients had mild TR(20.8%). Among the 24 patients, cardiac function was classified as NYHA Ⅰ, Ⅱ and Ⅲ in 17, 6 and 1 patients, respectively. Conclusion Cohn′s operation is effective for the treatment of TR. It should be emphasized that the therapeutic strategy should be based on clinical status, right heart function, pulmonary vascular resisteance, TR and tricuspid ring “Z” value.