目的 探讨二尖瓣病变合并肺动脉高压致三尖瓣关闭不全外科治疗的方法,总结相关治疗经验。 方法 回顾性分析2005年6月至2011年6月我院行外科手术治疗二尖瓣病变合并肺动脉高压致三尖瓣关闭不全118例患者的临床资料,男52例、女66例,年龄31~68 (48.25±9.83) 岁。三尖瓣轻度反流28例,中度反流59例,重度反流31例。所有患者术前均有不同程度的肺动脉高压(38~82 mm Hg)。术中行二尖瓣手术时同期行三尖瓣手术。体外循环停机后,术中采用经食管超声心动图(TEE)评价术后即刻治疗效果,出院前再次复查经胸超声心动图评价手术治疗效果。 结果 术中TEE结果提示,三尖瓣无反流50例,轻度反流67例,1例患者三尖瓣成形术后仍存在重度反流,遂再次在体外循环下行三尖瓣置换术。术后早期死亡4例(3.39%),其余患者均痊愈出院。随访12~84(41.72±22.90) 个月,完整随访105例,远期死亡3例,其余患者三尖瓣无反流30例,轻度反流66例,中度反流4例,重度反流2例。全组患者术后5年生存率为93.6%±2.4%;术后5年三尖瓣免除再手术率为94.9%±3.6%。 结论 对二尖瓣病变合并肺动脉高压所致的功能性三尖瓣关闭不全患者,在解决二尖瓣病变时同期纠治存在的三尖瓣病变,可降低术后三尖瓣的再手术率,早、中期疗效满意。术中根据三尖瓣瓣环的扩张程度选择适当的手术方式是提高手术治疗效果的关键。
Citation:
叶仙,唐,周荫北. 二尖瓣病变合并肺动脉高压致三尖瓣关闭不全的外科处理及中期随访. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 471-473. doi: 10.7507/1007-4848.20130140
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Rogers JH, Bolling SF. Valve repair for functional tricuspid valve regurgitation: anatomical and surgical considerations. Semin Thorac Cardiovasc Surg, 2010, 22 (1): 84-89.
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Reyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation:which should be the criteria for surgical repair ? Ann Thorac Surg, 2005, 79 (1): 127-132.
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陈天博, 胡盛寿, 肖学钧, 等. 对左心瓣膜病变所合并的功能性三尖瓣关闭不全的外科治疗. 广东医学, 2007, 28 (4):562-564.
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薛清, 徐志云, 韩林, 等. 二尖瓣成形术中轻度功能性三尖瓣反流的处理. 中国胸心血管外科临床杂志, 2011, 18 (6):503-506.
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Chikwe J, Anyanwu AC. Surgical strategies for functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22 (1): 90-96.
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朱鹏, 萧锡俊. 左心瓣膜病合并三尖瓣关闭不全的诊断及外科治疗. 心血管病学进展, 2007, 28 (2):293-295.
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- 1. Rogers JH, Bolling SF. Valve repair for functional tricuspid valve regurgitation: anatomical and surgical considerations. Semin Thorac Cardiovasc Surg, 2010, 22 (1): 84-89.
- 2. 肖学钧. 功能性三尖瓣反流的发生率、病因、预后及其外科处理. 岭南心血管病杂志, 2010, 16 (5):344-347.
- 3. Boyaci A, Gokce V, Topaloglu S, et al. Outcome of significant functional tricuspid regurgitation late after mitral valve replacement for predominant rheumatic mitral stenosis. Angiology, 2007, 58 (3): 336-342.
- 4. Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis, 2002, 11 (3): 353-356.
- 5. Reyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation:which should be the criteria for surgical repair ? Ann Thorac Surg, 2005, 79 (1): 127-132.
- 6. 陈天博, 胡盛寿, 肖学钧, 等. 对左心瓣膜病变所合并的功能性三尖瓣关闭不全的外科治疗. 广东医学, 2007, 28 (4):562-564.
- 7. 薛清, 徐志云, 韩林, 等. 二尖瓣成形术中轻度功能性三尖瓣反流的处理. 中国胸心血管外科临床杂志, 2011, 18 (6):503-506.
- 8. Chikwe J, Anyanwu AC. Surgical strategies for functional tricuspid regurgitation. Semin Thorac Cardiovasc Surg, 2010, 22 (1): 90-96.
- 9. 朱鹏, 萧锡俊. 左心瓣膜病合并三尖瓣关闭不全的诊断及外科治疗. 心血管病学进展, 2007, 28 (2):293-295.