以三尖瓣瓣环径结合体表面积作为三尖瓣成形手术指征有效性的初步临床观察  

Preliminary clinical observation of tricuspid annuloplasty adopting tricuspid annulus diameter and body surface area as surgical indication

作　　者：马小五[1] 张平洋[1] 张幼祥[1] 

机构地区：[1]南京医科大学附属南京医院南京市第一医院心血管超声科,江苏南京210006

出　　处：《临床荟萃》2013年第3期249-251,254,共4页Clinical Focus

基　　金：南京医科大学科技发展基金(08NMUM104)

摘　　要：目的应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)观察采用三尖瓣瓣环径结合体表面积作为三尖瓣成形术指征,是否有助于减少二尖瓣置换术(mitral valve replacement,MVR)患者术后中重度三尖瓣反流(tricuspid regurgitation,TR)的发生。方法回顾性分析2009年3月至2011年12月我院心外科收治的118例术前TR<中度的MVR患者。术前三尖瓣瓣环径/体表面积均≥21mm/m2,根据术中三尖瓣成形的有无和术后2年复查TR程度分为成形组(A、B亚组)和非成形组(C、D亚组),分别收集各组术前及术后2年的3-DE检查数据右心室舒张末期容积(RVEDV),右心室收缩末期容积(RVESV)及右心室毎搏量(RVSV)。结果三尖瓣成形组B组患者的术后RT-3DE指标RVEDV(124.9±23.9)ml、RVESV(59.2±11.6)ml和RVSV(56.9±9.8)ml,三尖瓣非成形组D组患者的术后RT-3DE指标RVEDV(128.7±21.8)ml、RVESV(60.1±10.0)ml和RVSV(57.8±10.7)ml,两者与术前RT-3DE指标比较差异均有统计学意义(P<0.05);A、B组间、C、D组间术后2年的RT-3DE指标间比较差异亦有统计学意义(P<0.01)。三尖瓣非成形组术后三尖瓣中-重度反流的发生率较高。结论对术前TR<中度的MVR患者,采用三尖瓣瓣环径结合体表面积作为三尖瓣成形手术参考指标可能有效地减少这些患者术后中或重度TR的发生。Objective To observe whether the adoptation of tricuspid annulus diameter and body surface area （BSA） as surgical indication for tricuspid annuloplasty will reduce the occurrence of moderate severe tricuspid regurgitation（TR） in patients with real-time three-dimensional echocardiography （RT-3DE） after mitral valve replacement（MVR）. Methods Between March 2009 and December 2011, MVR was performed in 118 patients with TR〈moderate and tricuspid annulus diameter/body surface area≥21 mm/m^2 in the Department of our Cardiovascular Surgery. According to the adoptation of the tricuspid annuloplasty in the operation and the degree of TR at two years＇ after operation, the patients were divided into tricuspid annuloplasty groups（A,B group） and no-tricuspid annuloplasty groups（C,D group）. The data of the RT-3DE,right ventricular end-diastolic volume（RVEDV）, right ventricular endsystolic volume（RVESV） and right ventricular stroke volume（RVSV） were collected in the groups before and two years after operation. Results B group＇ s data of RT-3DE in the tricuspid annuloplasty after operation were as following..RVEDV（124. 9±23. 9） ml,RVESV（59.2±11.6） ml and RVSV（56.9±9.8） ml,D group＇s data of RT- 3DE in the no-tricuspid annuloplasty after operation were as following.. RVEDV （ 128.7 ±21.8 ） ml, RVESV （ 60.1 ±10.0） ml and RVSV（57.8±10. 7） ml,the two groups＇ data had respectively significant differences with pre-operation; The RT-3DE＇s data of two groups,A and B,C and D,also had significant differences at the two years after operation. The occurrence of .moderate severe TR in no-tricuspid annuloplasty was higher than in the tricuspid annuloplasty. Conclusion The adoptation of tricuspid annulus diameter and RVEDV as surgical indication for tricuspid annuloplasty may reduce the occurrences of postoperative moderate-severe TR for patients of MVR with preoperative TR moderate.

关 键 词：心脏病 二尖瓣闭锁不全 三尖瓣闭锁不全 超声心动描记术 二尖瓣置换术 

分 类 号：R541[医药卫生—心血管疾病]