【摘要】 目的探讨在二尖瓣和/或动脉瓣置换术同期行三尖瓣成形术的合理手术指征、方法及围术期的处理。方法回顾分析三尖瓣成形术治疗三尖瓣关闭不全136例,其中行Devega成形65例,人工环成形48例,Key,s成形23例。同时行二尖瓣置换94例,二尖瓣+主动脉瓣置换42例。结果术后院内死亡5例,死亡率3.6%;迟发性心包填塞6例经心包引流治愈。术后随访2个月～8年,获访112例,5例死于顽固性心力衰竭,其余心功能明显改善。心脏超声示右心房及右心室较术前明显缩小。27例仍有轻中度返流。结论在瓣膜置换术中据三尖瓣环扩大的部位及返流程度,选择不同的成形方式对于三尖瓣关闭不全疗效满意。围术期及术后加强强心、利尿及扩血管治疗有效降低肺动脉高压,可进一步提高三尖瓣成形近、远期疗效。更多还原

【Abstract】 Objective To investigate the operation indication,surgical procedures and perioperative management in the mitral valve and aortic valve replacement and simultaneous tricuspid valvoplasty.Methods From December 2004 to May 2010,136 case with cardiac valve lesions received cardiac valve replacement and simultaneous tricuspid valvoplasty were analyzed retrospectively.Among them,Devega plasty,artificial annuloplasty and Key’s plasty were performed in 65,48 and 23 cases respectively.At the same time,mitral valve replacement,mitral valve plus aortic valve replacement were performed in 94 and 42 cases respectively.Results Postoperative death was in 5 cases and mortality was 3.6%.Delayed pericardial tamponade occurred,which were cured after pericardial drainage.Follow-up was got in 112 cases.Postoperative Follow-up ranged from 2 months to 8 years.Five cases died from refractory heart failure.The heart function was improved significantly in rest cases.The ultrasonic cardiograph showed that right atrium and ventricle were shortend significantly compared with the before operation.But,the 27 cases still had regurgitation in the mild to moderate degree.Conclusion In the cardiac valve replacement,according to the position of tricuspid ring enlargement and regurgitated degree to choice different value plasty procedures,it would get a satisfactory results for treating tricuspid insufficiency.Preoperative and postoperative enhancing cardio-tonic,diuretic and vasodilative treatment can effectively decline pulmonary hypertension and it could farther improve short-term and long-term curative effects for tricuspid valvuloplasty.更多还原