功能性三尖瓣反流机制的二维及三维超声心动图探索

The mechanism of functional tricuspid regurgitation：insight from two and three-dimensional echocardiography

目的应用超声心动图探索功能性三尖瓣反流的发生机制，并为手术治疗提供理论基础。方法对56例左心瓣膜疾病合并三尖瓣反流的患者进行超声检查，测量三尖瓣瓣环直径、瓣叶闭合高度、闭合长度、心室三维容积和射血分数。结果根据术前反流程度将56例患者分为轻度组（组1）和中度及以上组（组2），组2的瓣环直径、闭合高度、右室容积均明显大于组1（P〈0．01）。与反流程度重要相关的因素分别是瓣环直径、闭合高度、右室舒张末容积、肺动脉高压。术前三维超声发现合并瓣叶器质性改变会加重反流。结论合并左心瓣膜疾患的三尖瓣反流主要受瓣环扩张及肺动脉高压的严重程度影响。三维超声可以更直观地观察瓣叶结构。

Objective To explore determinants of functional tricuspid regurgitation with two- dimensional （2D） and three-dimensional （3D） echocardiography,and to provide theoretical basis for surgery treatments. Methods Fifty-six subjects with left-sided valular diseases and tricuspid regurgitation underwent 2D and 3D echocardiography examinations. The tricuspid annulus diameter, the valvular tethering height and right ventricular volume and ejection fraction were measured. Results Based on the degree of tricuspid regurgitation,the patients were grouped into mild regurgitation （group 1） and moderate or more regurgitation （group 2）. Comparing the two groups by t test, the tricuspid annulus diameter, the largest distance of tricuspid valvular tethering and the end-diastolic right ventricle volume had significantly enlarged in group 2 （ P 〈0. 01）. And the degrees of tricuspid regurgitation had good correlations with the annulus diameter, the valvular tethering,the right ventricular volume and pulmonary artery systolic pressure. Also, the 3D echocardiography revealed there were some valvular pathologies aggravating regurgitation. Conclusions The degree of functional tricuspid regurgitation is mainly determined by the annulus dilation and pulmonary hypertension. Further more,the 3D echocardiography can give us more details of the valves.