摘要
目的 总结风湿性三尖瓣疾病（RTVD）的特点及成形的中期疗效.方法 2009年1月至2016年6月共251例风湿性心脏病患者接受手术治疗,术中诊断RTVD 39例.其中中度及以上三尖瓣反流（TR）32例,与同期中度及以上功能性三尖瓣反流（FTR）59例进行比较,评估RTVD的特点.39例RTVD患者按手术方式2组：人工环组33例和非人工环组6例（改良De Vega线性成形4例、瓣缘对合2例）,同期交界切开13例,自体心包加宽三尖瓣前叶1例.共22例获得中期（〉1年）超声心动图随访资料,平均随访（45.5±25.1）个月.结果 与FTR患者相比,RTVD患者三尖瓣瓣环直径（TAD）较小[术前超声心动图测量值（37.0±5.7）mm对（41.9±6.7）mm,P=0.018;术中测量值,（35.6±4.1）mm对（39.9±6.5）mm,P=0.000],术前肺动脉收缩压较低[（53.8±19.4）mmHg对（63.6±21.5）mmHg,P=0.037）]（1 mmHg=0.133 kPa）,而TR更严重（3.1±0.8对2.6±0.7,P=0.004）.术后两组均无死亡,无残余中量及以上TR.与非人工环组相比,人工环组患者术后早期TR改善更满意（0.2±0.4对0.7±0.5,P=0.039）,随访时TR较轻（0.8±0.5对1.3±1.9,P〉0.050）.两组术后早期及随访时的肺动脉收缩压、舒张期三尖瓣前向流速和峰值跨瓣压差差异均无统计学意义.结论 与FTR相比,RTVD患者瓣环直径小、肺动脉收缩压低,但TR程度重;人工环成形术与其他成形术式中期疗效满意.
Objective The aim of this study was to summarize the characteristics of rheumatic tricuspid valve disease （ RTVD） and to evaluate the mid-term outcomes in patients undergoing tricuspid valve repair with RTVD. Methods Between January 2009 and June 2016, 251 consecutive patients with rheumatic heart disease（ RHD） underwent left-sided valvular re-placement by a single surgeon. We analyzed 39 patients with RTVD which was diagnosed during the operation. Among them, 32 patients, with moderate or higher tricuspid regurgitation（ TR） , were compared with other 59 patients of functional tricuspid regurgitation（ FTR） for a better understanding of the features of the RTVD. A total of 39 patients were categorized into 2 groups：Ring annuloplasty group（n=33） and non-Ring annuloplasty group（n=6） which consisted of modified De Vega annu-loplasty for 4 patients and edge-to-edge repair for 2. Meanwhile, 13 of them underwent concomitant tricuspid commissurotomy and 1 patient had a tricuspid leaflet augmentation procedure. We analyzed the mid-term outcomes of 22 patients（ follow-up du-ration〉1 year）with a mean follow-up duration of（45.5 ±25.1） months. Results Compared with FTR, patients with RTVD had higher preoperative TR grade（3.1 ±0.8 vs. 2.6 ±0.7, P=0.004） but with lower preoperative PASP[（53.8 ±19.4） mmHgvs.（63.6±21.5）mmHg,P=0.037）]（1mmHg=0.133kPa） andtricuspidannulusdiameter（TAD） thatobserved bothinpreoperativeechocardiogramtests[（37.0±5.7）mmvs.（41.9±6.7）mm,P=0.018）]andintraoperativedetection [（35.6±4.1）mmvs.（39.9±6.5）mm,P=0.000）] . TherewasnoearlymortalityandresidualmoderateorhigherTR grades in either group. Compared with patients in non-ring annuloplasty group, patients in ring annuloplasty group showed low-er postoperative TR grade（0. 2 ± 0. 4 vs. 0. 7 ± 0. 5, P=0. 039） and acceptable TR grade（0. 8 ± 0. 5 vs. 1. 3 ± 1. 9, P〉0. 050） during the mid-term follow-up. PASP, the peak diastolic velocity and pressure gradient across t
出处
《中华胸心血管外科杂志》
CSCD
2017年第12期716-720,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
风湿性三尖瓣疾病
器质性三尖瓣疾病
三尖瓣狭窄
三尖瓣关闭不全
Rheumatic tricuspid valve disease
Organic tricuspid valve disease
Tricuspid valve stenosis
Tricuspid valve insufficiency
