应用自体心包行器质性三尖瓣病变瓣膜成形术

Valvoplasty for organic tricuspid valval disease utilizing autogeneous pericardium

目的:介绍应用自体心包行器质性三尖瓣病变瓣膜成形术的方法和疗效。方法:应用0.2％戊二醛处理自体心包,采用三尖瓣前瓣叶加宽和粘连、融合的交界切开技术修复风湿性三尖瓣狭窄和关闭不全13例,同期二尖瓣置换7例、主动脉瓣和二尖瓣置换6例;采用病变瓣叶切除、自体心包片修复及人造腱索技术,手术治疗5例三尖瓣细菌性心内膜炎病变和1例多发性瓣膜黏液瘤病变,同期行室缺修补4例、佛氏窦瘤修补和主动脉瓣置换1例、二尖瓣置换和自体心包瓣肺动脉瓣置换1例。结果:19例患者无手术死亡,出院前心脏超声检查显示三尖瓣启闭良好。17例随访3个月至6年,复查心脏超声显示三尖瓣无反流5例,少量反流11例,中度反流1例。结论:对风湿性三尖瓣病变或局限性三尖瓣器质性病变应用自体心包片行瓣膜成形术可以取得优良的早期和中期疗效。

Objective:To introduce the surgical techniques and outcome of the valvoplasty for the organic tricuspid disease utilizing autogeneous pericardium. Methods: Autogeneous pericardium was pretreated in 0. 2% glutorudehyde solution for 10 min. Anterior tricuspid leaflet enlargement and commissurotomy were performed for rheumatic tricuspid disease in 13 cases, concomitant procedures included MVR in 7 cases, DVR in 6 cases. The diseased leaflet and the attached chordae were replaced respectively by pericardium and 5-0 Gore-tex suture in 5 cases with endocarditis and 1 cases with valvular myxoma, concomitant procedures included VSD repair in 4, valsalva fistula repair and AVR in 1, and MVR and pulmonary valve replacement with autogeneous pericardial stentless valve in 1. Results: There was no operative death. Echocardiogram showed good movement of leaflets in all 19 patients. Seventeen patients were followed up from 3 months to 6 years. Echocardiogram showed no regurgitation in 5, trivial regurgitation in 11, moderate regurgitation in 1. Conclusion: Valvoplasty with autogeneous pericardium in treating rheumatic or other localized tricuspid diseases can obtain satisfactory early and mid-term results.