【摘要】 目的了解二尖瓣置换术(MVR)后三尖瓣反流(TR)的逆转、残留或加重的情况,以改进对TR的临床评价及治疗。方法随访分析1998年1月至2003年12月所收治的MVR患者287例,其中男86例,女201例;年龄15~66岁(41.0±11.0岁)。二尖瓣狭窄199例(69%),二尖瓣反流66例(23%),二尖瓣狭窄伴关闭不全22例(8%);心房颤动201例(70%),窦性心律86例(30%)。根据最大反流束面积/右心房面积的比率将TR分为:轻度(+)、轻中度(+/++)、中度(++)、中重度(++/+++)和重度(+++)。术前轻度TR101例(36.7%),轻中度TR5例(1.8%),中度TR27例(9.8%),中重度TR2例(0.7%),重度TR21例(7.6%)。是否施行三尖瓣环缩手术主要根据术中探查。术后定期门诊随访及复查超声心动图。结果287例患者随访2~7年(4.0±1.6年),随访期间失访12例。手术后绝大多数患者的临床状况得到较大改善。与术前相比术后患者左心房(LA)、左心室(LV)缩小(P<0.01),左心功能亦较术前明显改善,射血分数(EF)和缩短分数(FS)增加(P<0.05);术后右心房(RA)、右心室(RV)亦较术前缩小(P<0.01)。但术后TR情况与术前相比差异无统计学意义(P>0.05)。由于术中探查判定TR不严重、129例术前存在TR的患者未施行三尖瓣环缩术,术后这些患者中TR消失54例、减轻12例、无明显变化46例、加重17例。术中施行DeVega三尖瓣环缩术27例,术后TR消失10例、减轻12例、无明显变化5例。结论以最大反流束面积/右房面积比率评价二尖瓣病变伴随的功能性TR的严重程度有明显的不足,采用术中探查决定是否施行三尖瓣环缩术的方法值得改进。TR可能发生于MVR前并无TR的患者。更多还原

【Abstract】 Objective To examine the regression, residue, or progression of tricuspid regurgitation (TR) after mitral valve replacement so as to improve the clinical evaluation and management of TR. Methods From January 1998 to December 2003, a total of 287 consecutive patients of mitral valve replacement were followed and reviewed for this study. There were 86 male patients and 201 female patients whose ages ranged from 15 to 66 years (41.0±11.0 years). The predominant mitral valve lesion was stenosis in 199 patients (69%), regurgitation in 66 patients (23%) and mixed in 22 patients (8%). A total of 201 patients (70%) had atrial fibrillation and 86 patients (30%) were in sinus rhythm. According to ratio of maximal regurgitation area to right atrial area TR was graded as mild (+), mild-moderate (+/++) moderate (++) moderate-severe (++/+++) and severe (+++). There were 101 mild TR (36.7%), 5 mild-moderate(1.8%), 27 moderate (9.8%), 2 moderate-severe (0.7%) and 21 severe (7.6%). Depending on the surgical findings tricuspid annuloplasty was performed. The patients were followed in outpatient clinical and had echocardiography evaluation regularly. [WTHZ]Results The follow-up ranged from 2 to 7 years (4.0±1.6 years). Twelve patients were lost during the follow-up periods. Compared with preoperation, clinical condition of the majority of patients was improved after surgery. The diameter of left atrium, right atrium, left ventricle and right ventricle decreased significantly after operation (P<0.01). The ejection fraction and fraction of shorting increased significantly after surgery (P<0.05). However there were no significantly changes between pre-TR and post-TR in these patients (P>0.05). Tricuspid annuloplasty was not performed for 129 patients who had TR because TR was judged intraoperatively not to be severe. Of those patients, TR regressed in 54 patients, improved in 12 patients, did not change in 46 patients and progressed in 17 patients respectively after surgery. There were 27 patients who received De Vega tricuspid annuloplasty. Among them, TR regressed in 10 patients, improved in 12 patients and did not change in 5 patients respectively after surgery. Conclusion It is not adequate to evaluate the degree of TR in mitral valve diseases with rate of maximal regurgitation area to right atrial area. It should be improved to adopt intraoperative findings for tricuspid annuloplasty. TR may occur in patients who do not have TR before operation.更多还原