三尖瓣前瓣增补法联合C形环植入治疗原发风湿性三尖瓣关闭不全的效果分析

Effect Analysis of Anterior Tricuspid Valve Supplementation Combined with C-ring Implantation in the Treatment of Primary Rheumatic Tricuspid Valve Insufficiency

目的:评价采用三尖瓣前瓣增补法联合C形环植入治疗原发风湿性三尖瓣重度关闭不全的临床效果。方法:选择2015年1月-2017年1月本院心外科收治的72例原发风湿性三尖瓣重度关闭不全患者为研究对象。患者均实施三尖瓣前瓣增补法联合C形环植入的成形手术。其中风湿性三尖瓣狭窄并重度关闭不全29例,三尖瓣瓣环扩大、瓣叶挛缩并重度关闭不全43例。扩大瓣叶材料为自体心包片32例,牛心包片38例,Gore Tex膜2例。植入Edwards MC3成形环43例,植入佰仁思C形环29例。评价所有患者的手术情况及手术效果,分析患者术前与术后1年的三尖瓣返流面积(TR)、右心房大小、肺动脉收缩压(PASP)、右心室Tei指数等指标变化情况。结果:患者手术均成功,无需置换三尖瓣,无死亡病例。术后心脏彩超提示手术效果满意,轻度三尖瓣关闭不全7例,微量关闭不全14例,无关闭不全51例,均顺利康复出院。随访12~36个月,心功能Ⅰ级62例,Ⅱ级10例,心胸比缩小,右心功能改善,近中期效果满意,无三尖瓣关闭不全加重、心包片明显钙化、组织溶血、血栓形成、感染心内膜炎等并发症发生。术后1年,研究对象的TR、右心房大小、PASP、Tei指数均小于术前,差异均有统计学意义(P<0.05)。结论:应用三尖瓣前瓣增补法联合C形环植入成形三尖瓣,可有效治疗原发风湿性三尖瓣重度关闭不全和改善右心功能,可避免三尖瓣置换。技术方法成熟,近中期效果满意,值得推广使用。

Objective:To evaluate the clinical effect of anterior tricuspid valve supplementation combined with C-ring implantation in the treatment of primary rheumatic tricuspid valve severe closure insufficiency.Method:A total of 72 patients with primary rheumatic tricuspid valve severe closure insufficiency admitted to the cardiac surgery department of our hospital from January 2015 to January 2017 were selected as the study subjects.All patients were operated by anterior tricuspid valve supplementation combined with C-ring implantation.There were 29 cases of rheumatic tricuspid stenosis with severe closure insufficiency,and 43 cases of tricuspid valve ring enlargement,valve leaf contracture and severe closure insufficiency.There were 32 cases with autologous pericardial tablets,38 cases with bovine pericardial tablets and 2 cases with Gore Tex membrane.The Edwards MC3 ring was implanted in 43 patients and the bayonet C-ring was implanted in 29 patients.All patients were evaluated for their surgical status and results,and the changes of tricuspid regurgitation area(TR),right atrium size,pulmonary artery systolic pressure(PASP),right ventricular Tei index and other indicators were analyzed before and 1 year after surgery.Result:The operation was successful in all patients,no tricuspid valve replacement was needed,and there were no deaths.Postoperative cardiac ultrasound indicated that the operation effect was satisfactory.7 patients with mild tricuspid valve insufficiency,14 patients with minimal valve insufficiency,and 51 patients without valve insufficiency were successfully recovered and discharged from hospital.Followed up for 12 to 36 months,heart functionⅠgrade 62 cases,Ⅱgrade 10 cases,breadth of mind than smaller,right heart function improvement,the near and medium term effect was satisfied,no tricuspid valve insufficiency,obvious calcification of pericardial tablets,tissue hemolysis,thrombosis,infective endocarditis and other complications occurred.One year after surgery,TR,right atrium size,PASP and Tei index of the subjects were all smaller than those before surgery,the differences were statistically significant(P<0.05).Conclusion:Anterior tricuspid valve supplementation combined with C-ring implantation can effectively treat primary rheumatic tricuspid valve severe closure insufficiency and improve right cardiac function,thus avoiding tricuspid valve replacement.The technical methods are mature and the results are satisfactory in the near and medium term,it is worth popularizing.