成形软环应用于三尖瓣关闭不全修复的疗效评价

Evaluation of Tricuspid Valve Repair With Flexible Ring Annuloplasty in Patients With Acquired Valvular Heart Disease

目的:了解国产三尖瓣成形软环对继发于左心系统瓣膜病变造成的三尖瓣关闭不全的治疗效果。方法:自2002-08至2004-08,我院收治的63例继发性三尖瓣关闭不全病人,在行左心系统瓣膜病变矫治时,应用国产三尖瓣成形软环同期行三尖瓣成形术。49例病人获得随诊,平均随诊时间为17.4±10.3(3～33)个月。结果:63例病人在术后早期均治愈出院。49例病人随诊时有1例病人死于非三尖瓣成形所致原因;其余48例随诊病人较术前症状均有改善,心功能较术前提高,超声检查示三尖瓣中量反流3例,大量反流1例。结论:国产三尖瓣成形软环对三尖瓣关闭不全有明显的治疗效果。成形效果优劣的关键在于术中对三尖瓣瓣环的有效处理。三尖瓣瓣环越大,则更应选择相对较小的人工瓣环,成形时不仅要缩小三尖瓣的游离缘瓣环,还要将部分三尖瓣隔瓣瓣环予以缩小和固定。

Objective：To evaluate the outcomes in application of domestic homemade flexible rings for tricuspid ring annuloptasty in treatment of tricuspid regurgitation（TR） secondary to the left heart valve disease. Methods ： A total of 63 patients with the secondary TR underwent flexible ring annuloplasty from August 2002 to August 2004 in our hospital were retrospectively evaluated ,49 patients were followed up with the mean time of 17.4 ± 10.3 （3 -33 ）months. Results ：There were no in-hospital death and all 63 patients were discharged after the operation. During the follow up period of time, 1 patient died for non-tricuspid annuloplasty reason, rest of 48 patients had improved cardiac function. Echocardiography showed that 3 patients had moderate TR and 1 had severe residual TR. Conclusion：Domestic homemade flexible rings were feasible for tricuspid ring annuloplasty of secondary TR. It had satisfied long-term outcomes. A relatively small ring should be chosen for large tricuspid annular. Repair should not only shorten and fasten the anterior and posterior annular, but also partly shorten and fasten septal annular.