左心瓣膜置换术后再次手术治疗三尖瓣功能性关闭不全的疗效分析  

Reoperation for tricuspid valve functional insufficiency after left heart valve replacement

作　　者：刘英军[1] Liu Yingjun(Department of Cardiovascular Surgery, Laizhou People＇s Hospital, Laizhou 261400, China)

机构地区：[1]莱州市人民医院心脏血管外科,261400

出　　处：《国际医药卫生导报》2017年第5期670-672,共3页International Medicine and Health Guidance News

摘　　要：目的探讨左心瓣膜置换术后再次手术治疗三尖瓣功能性关闭不全的疗效分析。方法2010年1月至2014年12月期间对12例左心瓣膜置换术后再次手术治疗三尖瓣关闭不全患者，曾行二尖瓣置换术4例，主动脉及二尖瓣置换术7例，主动脉瓣置换术1例。其中8例患者第1次手术时曾行三尖瓣成形术，采取手术治疗后的1～15年期间发生三尖瓣关闭不全，右心衰竭、腹水、肝大，心功能Ⅳ级。12例患者均再次手术，4例行三尖瓣置换术，8例行三尖瓣成形术。结果手术成活11例，死亡1例。术后随访1～5年，3例三尖瓣置换患者恢复良好；5例三尖瓣成形术心功能恢复良好，只有极轻度或轻度三尖瓣关闭不全；2例患者出现中度三尖瓣关闭不全，1例患者出现重度三尖瓣关闭不全。结论左心瓣膜置换术后包括部分同期行三尖瓣成形术患者，远期发生三尖瓣关闭不全，可能与以下原因有关：（1）左心瓣膜病变未纠正；（2）持续性肺动脉高压；（3）风湿性病变持续发展；（4）心房纤颤等因素；（5）原三尖瓣成形术失败。对重度三尖瓣关闭不全，发生右心功能衰竭者，应再次外科手术治疗。Objective To evaluate the effect of reoperation for tricuspid valve functional regurgitation after left heart valve replacement. Methods January, 2010 to December, 12 patients undertook reoperation after left ventricular value replacement 2014 at our hospital. Among which, 4 patients were treated with mitral valve replacement, 7 aortic and mitral valve replacement, and 1 aortic valve replacement. Eight patients underwent tricuspid plasty at the time of the first operation. Tricuspid regurgitation occurred 1 to 15 years after surgery. Right heart failure, ascites, and hepatomegaly were found. They had IV heart function. All the 12 patients underwent reoperation; 4 patients underwent tricuspid valve replacement and 8 tricuspid valvuloplasty. Results 11 cases survived and 1 died. The patients were followed up 1-5 years. 3 patients undertaking tricuspid valve replacement recovered well. Five patients undergoing tricuspid regurgitation got good recovery of heart function and only had very mild or mild tricuspid regurgitation. 2 patients got moderate tricuspid regurgitation and 1 severe. Conclusions Left ventricular valve replacement including tricuspid regurgitation after partial tricuspid valve replacement in the same period may relate with the following reasons： （1） left ventricular valve disease is not corrected; （2） persistent pulmonary hypertension; （3） sustained development of rheumatic disease; （4） atrial fibrillation and other factors; （5） original tricuspid valve failure. It is good to resurgically treat the patients after severe tricuspid regurgitation and right heart failure.

关 键 词：左心瓣膜置换术 三尖瓣关闭不全 再次手术 

分 类 号：R654.2[医药卫生—外科学]