Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Assoc...Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.展开更多
目的应用实时三维超声心动图(RT-3DE)评价WHO功能Ⅰ级肺动脉高压(WHO FCⅠPH)患者右心房功能。方法选取2014年2月~2016年6月在南方医科大学附属深圳宝安医院经临床诊断为WHO FCⅠ级PH、且经胸超声心动图三尖瓣反流法估测肺动脉收缩压(PA...目的应用实时三维超声心动图(RT-3DE)评价WHO功能Ⅰ级肺动脉高压(WHO FCⅠPH)患者右心房功能。方法选取2014年2月~2016年6月在南方医科大学附属深圳宝安医院经临床诊断为WHO FCⅠ级PH、且经胸超声心动图三尖瓣反流法估测肺动脉收缩压(PASP)≥40 mm Hg的患者41例为PH组,以及一般资料相匹配并经体检证实的健康者32例为正常对照组,采集所有研究对象右心房全容积图像,导入QLAB 9.0(10.5)软件分析,得到心动周期不同时相右心房容积,并以体表面积校正,得到右心房最大容积指数(RAVI_(max))、最小容积指数(RAVI_(min))、收缩前容积指数(RAVI_(pre))。并通过计算得到右心房总排空容积指数(RAVI_t),代表储存器功能;右心房被动排空容积指数(RAVI_p),右心房被动排空分数(RAEFp),代表管道功能;右心房主动排空容积指数(RAVI_a),右心房主动排空分数(RAEFa),代表助力泵功能。组织多普勒测量三尖瓣环右心室游离壁舒张期运动速度(e/a);M型超声测量三尖瓣环右心室游离壁收缩期位移(TAPSE),Simpson法测量右心室射血分数(RVEF)。比较两组间各参数的差异。结果与正常对照组比较,PH组TAPSE、RVEF差异无统计学意义(P>0.05),RAVI_(max)、RAVI_(pre)、RAVI_(min)、RAVI_t、RAVI_a显著增加(P<0.05或P<0.01),而RAVI_p、RAEFp、e/a显著减低(P<0.05)。结论 WHO FCⅠPH患者右心房管道功能减低,助力泵功能和储存器功能增强,RT-3DE提供了无创性评价的新方法。展开更多
文摘Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention. Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class. There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement. Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium. The TRI-SCORE was calculated for each patient. Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms. TR was markedly reduced;however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively. This patient later died from unknown causes due to multiple comorbidities in the late phase. Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool. The underlying mechanism by which TR exacerbates MR requires further investigation.
文摘目的应用实时三维超声心动图(RT-3DE)评价WHO功能Ⅰ级肺动脉高压(WHO FCⅠPH)患者右心房功能。方法选取2014年2月~2016年6月在南方医科大学附属深圳宝安医院经临床诊断为WHO FCⅠ级PH、且经胸超声心动图三尖瓣反流法估测肺动脉收缩压(PASP)≥40 mm Hg的患者41例为PH组,以及一般资料相匹配并经体检证实的健康者32例为正常对照组,采集所有研究对象右心房全容积图像,导入QLAB 9.0(10.5)软件分析,得到心动周期不同时相右心房容积,并以体表面积校正,得到右心房最大容积指数(RAVI_(max))、最小容积指数(RAVI_(min))、收缩前容积指数(RAVI_(pre))。并通过计算得到右心房总排空容积指数(RAVI_t),代表储存器功能;右心房被动排空容积指数(RAVI_p),右心房被动排空分数(RAEFp),代表管道功能;右心房主动排空容积指数(RAVI_a),右心房主动排空分数(RAEFa),代表助力泵功能。组织多普勒测量三尖瓣环右心室游离壁舒张期运动速度(e/a);M型超声测量三尖瓣环右心室游离壁收缩期位移(TAPSE),Simpson法测量右心室射血分数(RVEF)。比较两组间各参数的差异。结果与正常对照组比较,PH组TAPSE、RVEF差异无统计学意义(P>0.05),RAVI_(max)、RAVI_(pre)、RAVI_(min)、RAVI_t、RAVI_a显著增加(P<0.05或P<0.01),而RAVI_p、RAEFp、e/a显著减低(P<0.05)。结论 WHO FCⅠPH患者右心房管道功能减低,助力泵功能和储存器功能增强,RT-3DE提供了无创性评价的新方法。
