成功行经皮球囊二尖瓣成形术后功能性三尖瓣反流的远期随访

Long Term Outcome for Functional Tricuspid Regurgitation in Patients After Successful Percutaneous Balloon Mitral Valvuloplasty

目的：了解二尖瓣狭窄经皮球囊二尖瓣成形术（PBMV）后功能性三尖瓣反流（FTR）的远期变化情况。方法：人选自2000-01至2012—01我院成功完成PBMV764例连续病例，术前FTR≤2级为轻度，FTR≥3级为中重度。每1年门诊随访一次，将FTR仍为0级或减轻至少1级（重度FTR减轻至少2级）的患者称为逆转组，将FTR未减轻（FTR为0级除外）或加重或FTR≥3级的患者称为未逆转组。采用Cox多因素回归分析FTR未逆转的影响因素。结果：764例成功完成PBMV的患者随访1年内、1—3年、3～5年、5年以上FTR程度较术前均有明显改善（P均〈O．01），但中重度FTR（反流≥3级）患者在随访期间所占随访人群比例呈增加趋势（分别为7．1％、8．7％、15．8％、19．O％）。随访结束时，轻度FTR患者中逆转组逆转比率略高于中重度FTR患者（54．9％与46．1％，P〈0．05），发生≥3级FTR患者明显低于中重度TFR患者（3．1％与53．9％，P〈0．001）。Cox多因素回归分析显示在轻度患者中，心房颤动（房颤）、再狭窄为患者成功PBMV后FTR未逆转的预测因素；在中重度患者中，房颤、术前伴重度FTR及再狭窄为成功PBMV后FTR未逆转的预测因素。结论：大多数二尖瓣狭窄伴FTR≤2级的患者成功PBMV后FTR长期稳定于轻度及轻度以下；二尖瓣狭窄伴FTR≥3级的患者成功PBMV后应长期监测FTR进展情况，尤其对于合并房颤、术前伴重度FTR患者，FTR的进展与再狭窄密切相关。

Objective： To explore the long term outcome for functional tricuspid regurgitation （FTR） in patients after successful percutaneous balloon mitral valvuloplasty （PBMV）. Methods： We retrospectively studied 764 consecutive patients with mitral stenosis （MS） and received successful PBMV in our hospital from 2000 to 2012. The patients with pre-PBMV FTR≤2 degree was defined as mild level, pre-PBMV FTR 3 degree as moderate to severe level. The patients were followed-up once per year and divided into 2 groups, Reversion group, in which the patients had FTR at still 0 or regressed I〉 1 degree （the patients at severe level FTR regressed at least ≤2 degree） and No-reversion group, in which the patients had FTR unchanged, aggravated or ≤ 3 degree. Multivariate Cox regression analysis was conducted to study the influencing factors for FTR no-reversion. Results： With 1, 1-3, 3-5 and more than 5 years of follow-up, FTR obviously improved than they were before the operation, all P〈0.01, in patients at moderate to severe level, FTR increased for 7.1%, 8.7%, 15.8% and 19.0% respectively. By the end of follow-up time, the FTR reversion rate in mild patients was higher than that in moderate to severe patients,54.9% vs 46.1%, P〈0.05. The incidence for having morderate to severe FTR in mild patients was less than moderate to severe patients, 3.1% vs 53.9%, P〈0.001. Multivariate Cox regression analysis showed that in mild patients, atrial fibrillation （AF） and restenosis were the predictors for FTR no-reversion after PBMV, in moderate to severe patients, AF, severe TR before the operation and restenosis were the predictors for FTR no-reversion after PBMV. Conclusion： Successful PBMV in most MS patients with FTR ~〈2 degree before operation could maintain a stable mild or better than mild FTR condition, long term monitoring is necessary for patients with FTR ≥ 3 degree before operation. The progress of FTR after PBMV is related to AF and restenosis.