永久心脏起搏器电极相关三尖瓣病变的病因及外科治疗效果  

Surgical treatment of tricuspid valve disease due to permanent pacemaker lead

作　　者：任崇雷[1] 姚名辉[1] 张林[1] 王嵘[1] 姜胜利[1] Ren Chonglei;Yao Minghui;Zhang Lin;Wang Rong;Jiang Shengli(Department of Cardiovascular Surgery,First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管外科,北京100853

出　　处：《中华医学杂志》2020年第40期3147-3151,共5页National Medical Journal of China

摘　　要：目的总结永久心脏起搏器电极相关三尖瓣病变的病因及外科治疗经验。方法回顾性分析2008年1月至2017年12月解放军总医院第一医学中心心血管外科收治的永久心脏起搏器电极相关三尖瓣病变行外科治疗的22例患者资料,其中男12例,女10例,年龄45~82(62.6±12.1)岁。均在体外循环下行开胸三尖瓣手术,其中,正中开胸手术8例,右侧小切口开胸4例,腔镜辅助及全腔镜手术10例;三尖瓣置换8例,三尖瓣成形术14例。结果术中见起搏电极累及三尖瓣及瓣下结构10例,三尖瓣瓣环扩张7例,起搏电极相关感染性心内膜炎累及三尖瓣5例。与常规开胸手术相比,微创手术包括右胸小切口手术及胸腔镜手术的术后24 h引流量[281(120,489)ml比368(180,560)ml,P=0.02]、住院时间[9.2(4.8,14.5)d比11.2(6.3,16.9)d,P=0.03]均减少。术后超声心动图检查显示,所有患者右房右室较术前明显减小,心功能正常。术后起搏器程控仪检测起搏电极参数(感知度、起搏阈值、起搏阻抗)与术前比较差异均无统计学意义(均P>0.05)。所有患者均治愈出院,无瓣膜及起搏器相关并发症。结论永久心脏起搏器电极相关三尖瓣病变根据不同的病因机制积极外科手术行三尖瓣置换或成形术结果满意。微创腔镜三尖瓣手术是治疗单纯三尖瓣病变的新技术,创伤小、恢复快。Objective To summarize the etiology and surgical treatment experience of tricuspid valve disease due to permanent pacemaker lead.Methods The medical records of 22 patients who underwent tricuspid valve operation for tricuspid valve disease due to permanent cardiac pacemaker lead from January 2008 to December 2017 were retrospectively reviewed.There were 12 males and 10 females,with a mean age of(62.6±12.1)years old(45-82 years old).All patients underwent tricuspid valve surgery via open thoracotomy under general anesthesia,including 8 patients through median thoracotomy approach,4 patients through right mini-thoracotomy approach,and 10 patients with endoscopy-assisted and totally endoscopic technique.Moreover,8 patients underwent tricuspid valve replacement,and 14 patients received tricuspid valve repair.Results During the operation,10 cases of severe tricuspid regurgitation were detected due to valve and subvalvular structures dysfunction involved in the pacing electrode,7 cases showed tricuspid annulus dilation,and pacing electrode-related infective endocarditis were involved in the tricuspid valve of 5 cases.Compared with conventional median thoracotomy surgery,the amount of postoperative drainage fluid and hospitalization time after minimally invasive surgery(including right mini-thoracotomy and endoscopic surgery)were significantly reduced[281(120,489)ml vs 368(180,560)ml,P=0.02;9.2(4.8,14.5)d vs 11.2(6.3,16.9)d,P=0.03].Postoperative echocardiographic data showed that the size of the right atrium and ventricle in these patients was significantly reduced compared with preoperative data,and their cardiac function were normal.There was no difference of pacing electrode parameters between pre-and postoperative period.All 22 patients were cured and discharged,with no valve-and pacemaker-related complications.Conclusions Patients with tricuspid valve disease due to permanent cardiac pacemaker lead should actively undergo surgery including tricuspid replacement or repair according to different etiologies,which exh

关 键 词：心脏瓣膜疾病 三尖瓣闭锁不全 心脏起搏器 三尖瓣手术 心内膜炎 

分 类 号：R654.2[医药卫生—外科学]