永久性心脏起搏器导线所致三尖瓣重度关闭不全的病因及外科治疗

Etiology and Surgical Treatment of Severe Tricuspid Insufficiency Caused by Permanent Pacemaker Leads

目的探讨永久性起搏器植入术后三尖瓣重度关闭不全的临床特点及外科治疗近期效果。方法回顾成都市第三人民医院心脏大血管外科于2013年1月—2019年5月收治的15例永久性起搏器植入术后导线所致三尖瓣重度关闭不全并行手术治疗患者的临床资料:术中观察的致病原因、手术策略、术后并发症及近期治疗效果。结果15例患者中2例因隔瓣穿孔导致,1例因导线缠绕导致,5例因导线与三尖瓣粘连导致,7例因导线冲击三尖瓣导致。15例患者中8例行正中开胸体外循环三尖瓣手术,7例患者行右侧肋间小切口三尖瓣手术。其中5例患者行三尖瓣成型环成型,2例患者行瓣叶修补,1例患者行三尖瓣生物瓣置换,2例患者行De Vega成型,3例患者行导线松解固定+K氏成型,2例患者行导线去除。所有患者均未发生严重围手术期并发症及死亡。术后1周复查心脏彩色超声未发现明显三尖瓣反流。结论永久性起搏器导线可导致严重的三尖瓣关闭不全,外科手术治疗起搏器导线相关的三尖瓣关闭不全安全和有效。

Objective To investigate the clinical characteristics and the short-term effect of surgical treatment of tricuspid insufficiency after permanent pacemaker implantation.Methods The clinical data of 15 patients with severe tricuspid insufficiency due to lead after permanent pacemaker implantation who were admitted to the Department of Cardiovascular Surgery in The Third People,s Hospital of Chengdu from January 2013 to May 2019 were reviewed.These data include the etiology observed during operation,surgical strategies,postoperative complications and short-term therapeutic effects.Results Among the 15 patients,2 cases were caused by perforation of septum valve,1 case by wire winding,5 cases by wire adhesion to tricuspid valve and 7 cases by wire impact to tricuspid valve.Of the 15 patients,8 underwent median thoracotomy under cardiopulmonary bypass for tricuspid valve surgery and 7 underwent right intercostal mini-incision tricuspid valve surgery.Of the 15 patients,5 underwent tricuspid valve ring formation,2 underwent valve repair,1 underwent tricuspid valve replacement,2 underwent De Vega formation,3 underwent wire release and fixation and K-formation,and 2 underwent wire removal.No serious perioperative complications and perioperative death occurred.No serious tricuspid regurgitation was detected by color Doppler echocardiography one week after surgery.Conclusion Permanent pacemaker wires can cause severe tricuspid insufficiency,and surgical treatment of lead-induced tricuspid insufficiency is safe and effective.