对三尖瓣反流的评估及处理的意义和方法

Significance and Techniques of Assessment and Treatment of the Tricuspid Valve Regurgitation

功能性三尖瓣反流(tricuspid valve regurgitation,TR)常继发于左心瓣膜疾病。对TR程度的准确评估、合理处理可以改善患者的长期预后。目前认为中度TR或术前超声检查舒张期末三尖瓣环直径>40 mm、三尖瓣直径/体表面积>21 mm/m^2或术中测量三尖瓣直径>70 mm,特别是合并心房纤颤、心房扩大时,在左心瓣膜手术时应同期矫正TR,以防止TR进一步加重而导致临床症状加重和心功能下降。成形环的使用可以有效防止TR远期复发,三尖瓣成形尽量使用硬/半硬C形成形环,三尖瓣置换术的近远期死亡率较高,应尽量避免。

Functional tricuspid valve regurgitation （TR） is often secondary to left-sided valvular heart diseases. The precise diagnosis of TR degree and reasonable treatment can improve the long-term prognosis of patient. Now we believe that rectifying the TR during left cardiac valve surgery can prevent a further development of TR and avoid the reducing of the cardiac function for patients with moderate TR, tricuspid valve annulus diameter〉40 mm in late diastole, tricuspid valve diameter/body surface area〉21 mm/m2, and intraoperative tricuspid valve diameter 〉70 mm, especially for patients with atrial fibrillation and atrial enlargement. The use of prosthetic ring can effectively prevent recurrence of TR in long term and we should try to use hard or semihard ＂C＂ shape prosthetic ring as much as possible. The tricuspid valve replacement should be avioded because of its higher mortality.