摘要
目的 报告二尖瓣置换 (MVR)术后远期三尖瓣关闭不全 (TR)外科治疗的结果及作用。方法 37例MVR术后中重度TR病人 ,其中人工二尖瓣为生物瓣者 13例 ,机械瓣 2 4例。有 11例行内科保守治疗 ,2 6例行外科手术治疗。手术类型 :MVR加三尖瓣置换 2例 ,MVR加三尖瓣成形 11例 ,三尖瓣置换 3例 ,三尖瓣成形 10例。三尖瓣成形术包括改良Kay成形术 12例 ,改良DeVega成形术 7例 ,加成形环的三尖瓣成形术 2例。结果 11例内科治疗者 ,7个月～ 7 5年后 6例死亡 ,病死率为 5 4 5 %。 2 6例手术治疗者 ,术后早期病死 2例 ,病死率为 7 7% ,随访 8个月～ 10 5年 ,晚期死亡 1例 ,仍中度TR 2例。结论 MVR术后远期TR的产生与不可逆的右心损害或 (和 )严重肺动脉高压有关 ;对重度TR伴有临床症状、左心功能基本正常者 ,行三尖瓣成形或三尖瓣置换术可取得良好的效果。
Objective: To report the results and role of surgical treatment of functional tricuspid regurgitation (TR) late after mitral valve replacement (MVR). Methods: There were thirty-seven patients with moderate to severe functional TR after MVR. Prior MVR was performed with mechanical valve in 24 cases and biological valve in 13. 11 patients received medical therapy, and 26 surgical treatment. The types of surgery included MVR and tricuspid valve replacement in 3 and tricuspid valve annuloplasty in 10. Three different methods of tricuspid valve annuloplasty were used for correction of TR, including modified Kay annuloplasty in 12 cases and modified DeVega annuloplasty in 7 and tricuspid valve ring annuloplasty in 2. Results: Six of 11 patients who received medical therapy died within 7 months to 7.5 years and the mortality rate was 54.5%. Two of 26 patients who received surgical treatment died early after operation and the hospital mortality rate was 7.7%. The 24 survivors were followed up from 8 months to 10.5 years and there was one late death and 2 had moderate functional TR. Conclusions: The irreversible right heart impairment and/or servere pulmonary hypertension are responsible for the development of late functional TR after MVR. The surgical management of the TR, which include tricuspid valve replacement and tricuspid valve annuloplasty may achieve excellent results in the patients with significant clinical symptoms and preserved left ventricular functions.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2001年第1期16-18,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
全军"九五"医药卫生科研基金!(编号 96Z0 3 1)
