三尖瓣置换手术19例体会

Experience of 19 cases of tricuspid valve replacement

目的 评价三尖瓣置换术（TVR）治疗三尖瓣病变的效果.方法 回顾性分析2008年1月至 2011年7月期间19例在我院接受三尖瓣置换手术患者的临床资料,其中置换生物瓣10枚,机械瓣9枚.按病因分为风湿性心脏病变、先天性病变及其他病变组.比较总体及风湿性病变患者（其他组数据较少）术前情况与预后的差异.结果 围术期 2例患者死亡;术后随访3～36个月,死亡1例.随访过程中,总体及风湿性病变患者右心房、右心室较术前明显缩小[总体由（33.2±10.1）mm降至（26.4±8.6）mm,风心病组由（27.4±6.3）mm降至（22.7±7.3）mm,P〈0.05],射血分数较术前明显提高[总体由（53.6±6.5）%提高至术后（61.1±6.7）%,风心病组由（52.2±5.8）%提高至（60.6±6.5）%,P〈0.05],近、中期术后效果良好.结论 目前对多种原因导致的三尖瓣病变虽力求修复治疗,但三尖瓣置换手术仍为目前严重器质性三尖瓣病变的最终治疗手段,应严格掌握手术时机与手术适应证.

Objective To evaluate the effect of tricuspid valve replacement （TVR）on the treatment of tricuspid valve disease. Methods The clinical data of 19 TVRs from January 2008 to July 2011 in the 3rd Ward of Cardiovascular Surgery,the 2nd Affiliated Hospital of Harbin Medical University were retrospectively reviewed. Among them 10 were replaced with mechanical valves and 9 with biological valves. The patients were divided to rheumatic heart disease（RHD） group, congenital heart disease group, and other lesions group according to etiology. The differences between pre - and post - operative conditions in overall level and in RHD group were compared. Results There were 2 perioperative deaths and 1 late death during the follow - up of 3- 36 months. In the follow - up, right atrium and right ventricle were significantly reduced （ from 33.2 ± 10.1 mm to 26.4 ± 8.6mm in general, from 27.4 ± 6.3 to 22.7 ± 7.3 in RHD group, P 〈 0.05 ）, left ventricular ejection fraction was significantly enhanced （ from 53.6 ± 6.5 % to 61.1 ± 6.7% in general, from 52.2 ± 5.8% to 60.6 ± 6.5% in RHD group,P 〈 0.05 ）. Short - term and mid - term outcomes were satisfying. Conclusion Although tricuspid valve disease caused by a variety of reasons strives for repair, TVR is still the final treatment of severe organic tricuspid valve disease, and the timing and indications of surgery should be strictly controlled.