改良三尖瓣成形术对继发性三尖瓣关闭不全的疗效评价  

Evaluation of Modified Cosgrove-Edwards Tricuspid Valve Annuloplasty for Treating the Patients With Secondary Tricuspid Regurgitation

作　　者：潘世伟[1] 胡盛寿[1] 王巍[1] 郑哲[1] 胡晓鹏[1] 孙寒松[1] 许建屏[1] 李鹏[1] 汪胜[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院成人外科中心,北京市100037

出　　处：《中国循环杂志》2011年第1期46-49,共4页Chinese Circulation Journal

摘　　要：目的:改良Cosgrove-Edwards(CE)三尖瓣成形术对继发性三尖瓣关闭不全(TI)的临床疗效评价。方法:2002-08至2007-12,连续对51例左心系统瓣膜病变,合并中量以上反流的三尖瓣关闭不全患者进行矫治。2004年以前的患者,采用经典的CE三尖瓣成形术(CE组,n=14);2004年后的患者,采用CE改良术(改良CE组,n=37)。51例患者根据术中发现,单纯三尖瓣瓣环扩大的为非风湿者(n=37),同时合并风湿性改变的为风湿者(n=14)。术后50例存活患者获得远期随诊,平均术后随诊时间为(47.08±22.08)个月。结果:三尖瓣成形效果的比较①改良CE组与CE组比较,术后三尖瓣瓣环直径[(26.2±1.7)mm vs(27.7±2.0)mm]、三尖瓣成形环的尺寸(28.1±2.1 vs 29.5±1.5)均缩小,术后1周左右残余三尖瓣中量反流的发生率降低(2.7%vs 21.4%),差异有统计学意义(P<0.05)。②风湿者与非风湿者三尖瓣成形结果比较:术前既往瓣膜手术史的发生率高(50.0%vs 13.5%),舒张期三尖瓣流速增加[(1.4±0.4)m/s vs(0.9±0.2)m/s],肺动脉收缩压降低[(54.6±22.2)mmHg vs(72.5±22.6)mmHg,1 mmHg=0.133 kPa],三尖瓣瓣环直径[(37.0±6.2)mm vs(48.2±8.3)mm]缩小,差异均有统计学意义(P<0.05)。结论:改良三尖瓣成形术即选择性小号人工瓣环成形方法,对于继发性TI治疗效果良好;同时继发性TI是一种进行性病变,对其矫治,也应个体化,以期达到最佳的治疗效果。Objective ：To evaluate the clinical outcomes of modified Cosgrove-Edwards tricuspid valve annuloplasty for treating the patients with secondary tricuspid regurgitation. Methods：We performed tricuspid valve annuloplasty with homemade flexible ＂C＂ shape ring in 51 consecutive patients who suffered from moderate to severe secondary tricuspid valve regurgitation from 2002 to 2007 in our hospital. The patients were di- vided into two groups. 14 patients received classic Cosgrove-Edwards tricuspid valve annuloplasty before 2004 （CE group）, and 37 patients received modified Cosgrove-Edwards tricuspid valve annuloplasty after 2004（ MCE group）. During the operation,we found that 14 patients combined with rheumatic changes in their tricuspid valve and 37 patients without it. 50 patients survived and received the follow-up study at the mean time of （47.08 ±22. 08） months. Results ： ①The patients in MCE group received smaller sized tricuspid ring than those in CE group （28. 1 ± 2. 1 vs. 29. 5 ± 1.5 ） in the operation, the patients had smaller post-operative tricuspid valve diameter （ 26. 2 ± 1.7 ） mm vs. （ 27. 7 ± 2.0） mm, and less post-operative moderate tricuspid regurgitation ,2. 8% vs. 21.4%, P 〈 O. 05 respectively. ②The patients with rheumatic disease had more previous history of valve operation than those without it,50. 0% vs. 13.5% ,had decreased pulmonary systolic pressure （ 54. 6 ± 22. 2） mmHg vs. （ 72. 5 ± 22. 6 ） mmHg and smaller tricuspid valve diameter （ 37.0 ±6.2 ） mm vs. （ 48.2 ± 8.3 ） mm before the operation, P 〈 0.05 respectively. Conclusion：The modified tricuspid valve annuloplasty with smaller flexible ring is effective for treating the secondary tricuspid regurgitation. An individualized annuloplasty should be performed according to the pathological changes in different patient.

关 键 词：三尖瓣关闭不全 成形术 瓣膜成形环 

分 类 号：R541[医药卫生—心血管疾病]