三尖瓣成形在左心瓣膜替换中的应用

Application of Tricuspid Annuloplasty in Left-sided Valve Replacement Operations

目的 :总结三尖瓣成形经验。方法 :35例二尖瓣或二尖瓣加主动脉瓣替换患者同时行三尖瓣膜成形。术前心功能Ⅲ、Ⅳ级 2 7例。超声提示 :三尖瓣呈中 -重度关闭不全 2 3例 ,轻度或无关闭不全但瓣环扩张大于 35mm 12例。行DeVega成形 31例 ,Kay成形 4例。结果 :手术死亡 3例 (8.6 % ) ,对 2 9例作了随访 ,平均随访 4.6个病人年 ,4年生存率为 86 %。结论 :三尖瓣成形能改善左心瓣膜替换患者近远期手术结果。对超声提示三尖瓣明显关闭不全或三尖瓣环直径大于 35mm者应行三尖瓣成形。通常将扩大的瓣环缩小至 30mm ,多可使返流减少或消失。

Objective: To examine the application of tricuspid annuloplasty in patients undergoing mitral and aortic valve replacement.Methods: Tricuspid annuloplasty was performed in 35 patients undergoing mitral or mitral plus aortic valve replacement in the author's hospital. All patients had rheumatic valvular heart disease. The preoperative indications measured by echocardiography were moderate to severe tricuspid regurgitation (TR) in 23 patients, and mild or no TR with a dilated tricuspid annulus of>35 mm in 12 patients. NYHA heart function was class Ⅲ to Ⅳ in 27 patients. Mitral valve or mitral and aortic replacements were performed in all patients. DeVega and Kay annuloplasty were carried out in 31 cases and 4 cases, respectively.Results: There were 3 early operative deaths (8.6%). The mean follow up was 4.6 patient years in 29 patients. Four year survival rate was 86%.Conclusion: Patients with rheumatic multivalvular diseases are often associated with pulmonary hypertension and both left and right ventricular dysfunction. Thus, preoperative echocardiographically documented moderate or severe TR or a tricuspid annulus diameter of>35 mm are valid indications for performing tricuspid annuloplasty. Tricuspid annuloplasty is a durable procedure in TR patients. It appears that reducing the dilated tricuspid annulus diameter to 30 mm can prevent residual TR.