应用自体心包片延伸三尖瓣前叶结合人工瓣环成形术治疗重度三尖瓣关闭不全

Association of autologous pericardium repair to artificial ring annuloplasty to treate severe tricuspid regurgitation

目的:探索应用自体心包片延伸三尖瓣前叶治疗重度三尖瓣关闭不全的手术方法,并评价其临床效果。方法:自2009年1月至2012年5月,对31例重度三尖瓣关闭不全患者,采用自体心包片延伸三尖瓣前叶手术结合人工瓣环成形术进行治疗。并通过术前、术后心脏超声测量Tei指数及右心房变化,反映三尖瓣手术结果,评价手术效果。结果:手术患者均顺利出院,无手术死亡,患者手术后心脏超声提示三尖瓣轻度关闭不全4例,微量反流5例,无反流22例,均顺利出院。随访4～40个月,31例患者心功能恢复良好,Ⅰ～Ⅱ级,Tei指数明显下降,右心功能改善。三尖瓣关闭不全除1例有早期的轻度关闭不全变成轻-中度关闭不全外,其余没有变化。结论:自体心包片延伸三尖瓣前叶结合人工瓣环成形术,是一种治疗重度三尖瓣关闭不全的较为理想的手术方式,在短期内基本消除了残余反流/复发反流。长期随访将证明其消除残余反流/复发反流的疗效。

Objective：This paper was to explore a new cardiac surgical procedure which association of autologous pericardium repair to artificial ring annuloplasty treated severe tricuspid regurgitation（STR）,and to analyze results of the study.Methods： From January 2009 to May 2012,31 patients underwent severe tricuspid regurgitation accepted surgical operations which artificial ring associated with augmented the anterior tricuspid leaflet using autologous pericardium.Then Tei indexes and right atrial diameters were measured in the peri-operation and post-operation to assess outcomes of the annuloplasty.Results： All the patients discharged on time,in the seventh days echocardiography proclaimed ： mild tricuspid regurgitation（TR） in 4 patients,trivial TR in 5 patients,no TR in others.4～40 months follow-up were available on all patients whom were in NYHA class Ⅰor Ⅱ and only one patient had moderate TR.All Tei indexes decreased form to demonstrate the cardiac function were obviously improved.Conclusion： Association of augmentation the anterior tricuspid leaflet using autologous pericardium to artificial ring annuloplasty was easy to perform and cost-effective,also achieved obviously outcomes in treatment of severe severe tricuspid regurgitation due to lesion of tricuspid leaflet and dilatation of tricuspid annulus.Early results were proved to obtain obviously improved cardiac function,long-term follow-up would be further affirmed.