成人三尖瓣置换33例临床结果分析  

The experience of tricuspid valve replacement in 33 adults

作　　者：吕涵 王克学[1] 宋鹏[1] 刘晨虎[1] 郑向阳[1] 何发明[1] 梁志强[1] LV Han;WANG Ke-xue;SONG Peng;LIU Chen-hu;ZHENG Xiang-yang;HE Fa-ming;LIANG Zhi-qiang(Department of Cardiac Surgery,Henan Province Chest Hospital,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省胸科医院心外科,河南郑州450003

出　　处：《广东医学》2020年第10期1051-1053,1058,共4页Guangdong Medical Journal

基　　金：河南省卫计委重点项目(201502025)。

摘　　要：目的分析三尖瓣置换术中不同种类人工瓣膜的临床应用效果差异。方法回顾性分析成人三尖瓣置换33例临床资料,其中男11例,女22例,手术时年龄(47±15)岁。术前心功能Ⅳ级(NYHA分级)15例,Ⅲ级17例,Ⅱ级1例。病因学上风湿性心脏病15例,退行性变2例,心肌梗死1例,先天性三尖瓣畸形、瓣叶病变11例,室间隔缺损发生感染性心内膜炎波及三尖瓣的4例。33例中有20例有体外循环下心内直视手术史,有2例曾经做过三尖瓣机械瓣置换,这次因机械瓣失功手术。都是采用三尖瓣原位置换,选择生物瓣19例,机械瓣14例。结果手术30 d内死亡3例,随访率100%,随访时间38(22,44)个月,远期死亡3例,其中2例死于心功能衰竭,1例因抑郁症自杀。因生物瓣衰败行三尖瓣再次置换1例。27例存活患者心功能NYHA分级Ⅰ级12例、Ⅱ级11例、Ⅲ级3例、Ⅳ级1例。结论虽然三尖瓣置换的近期和远期病死率均较高,但存活患者心功能总体较置换前明显改善,获益较大,对于有指征的患者,应该及早手术。Objective To analyze the clinical outcome of tricuspid valve replacement.Methods Thirty-three adult patients with tricuspid valve replacement were completed between January 2014 and December 2018,including 11 males and 22 females.The age was 47±15 years.Before surgery,15 patients were NYHAⅣ,17 patients were NYHAⅢ,and 1 patient was NYHAⅡ.According to the etiology,there were 15 patients with rheumatic heart disease,2 patients with degenerative disease,1 patient with myocardial infarction,11 patients with congenital tricuspid malformation and valve leaflet disease,and 4 patients who suffered from infective endocarditis due to ventricular septal defect and thus affected the tricuspid valve.Among the 33 patients,there were 20 patients with the history of open-heart surgery under cardiopulmonary bypass,2 patients who had received tricuspid valve replacement(mechanical valve)and received surgery this time due to mechanical valve dysfunction.They all received in situ tricuspid valve replacement,among them 19 patients chose biological valve and 14 patients chose mechanical valve.Results Threepatients died in 30 days after surgery.The follow-up rate was 100%,and the follow-up was 38(22-44)months.There were 3 late deaths,among whom 2 patients died of heart failure and 1 patient committed suicide because of depression.Onepatient received tricuspid valve replacement once again due to biological valve failure.Among the survived 27 patents,12 patients were NYHAⅠ,11 patients were NYHAⅡ,3 patients were NYHAⅢ,and 1 patients were NYHAⅣ.Conclusion Although the early and late mortality rates of tricuspid valve replacement are higher,survivors'overall cardiac function is significantly better than that before replacement.So the benefit is great.For patients with indications,tricuspid valve replacement should be performed as early as possible.

关 键 词：三尖瓣 人工瓣膜置换 NYHA分级 

分 类 号：R542.5[医药卫生—心血管疾病] R331.31[医药卫生—内科学]