基于反流容积的功能性三尖瓣反流治疗的长期评估：基于原发性心脏病变的特征差异

Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume: characteristic differences based on primary cardiac lesion.

作者信息

Sugimoto T, Okada M, Ozaki N, Hatakeyama T, Kawahira T

机构信息

Department of Surgery, Division II, Kobe University School of Medicine, Kobe, Japan.

出版信息

J Thorac Cardiovasc Surg. 1999 Mar;117(3):463-71. doi: 10.1016/s0022-5223(99)70325-9.

DOI:10.1016/s0022-5223(99)70325-9

PMID:10047648

Abstract

OBJECTIVES

The aim of this study was to characterize differences in the long-term effects of treatment for functional tricuspid regurgitation based on the primary cardiac lesion.

METHODS

Ninety-six patients with valvular heart disease and 32 patients with atrial septal defects associated with tricuspid regurgitation were studied. The tricuspid annular diameter was associated with evidence of right heart failure. In valvular heart disease, a Kay annuloplasty was performed in 33 patients with a tricuspid annular diameter of >/=40 mm to 44 mm, a modified De Vega annuloplasty in 12 patients with a tricuspid annular diameter of >/=45 mm to 49 mm, and a modified De Vega annuloplasty, annuloplasty using a Carpentier ring, or tricuspid valve replacement in each of 4 patients with a tricuspid annular diameter of >/=50 mm. In atrial septal defects, a Kay annuloplasty was performed in 11 patients with a tricuspid annular diameter of >/=45 mm to 49 mm, and a modified De Vega annuloplasty was performed in 5 patients with a tricuspid annular diameter of >/=50 mm. A mean follow-up period was 79 months after operation.

RESULTS

In the patients with a tricuspid annular diameter of <50 mm, the hemodynamic and clinical findings and tricuspid regurgitation remarkably improved. In the patients with valvular heart disease with a tricuspid annular diameter of >/=50 mm, however, the right heart parameters also showed improvement but less so when compared with those patients with a tricuspid annular diameter of <50 mm. In addition, 4 patients undergoing a modified De Vega annuloplasty have had a gradual increase in tricuspid regurgitation and clinical manifestations late after the operation. In contrast, all 5 patients with atrial septal defects with a tricuspid annular diameter of >/=50 mm have shown remarkable improvement, similar to those with a tricuspid annular diameter of <50 mm. Preoperative analyses revealed that the right heart function in atrial septal defects had not deteriorated to the same extent as in valvular heart disease.

CONCLUSION

In the patients with a severely dilated tricuspid anulus (>/=50 mm), the postoperative change of tricuspid regurgitation differed between those patients with valvular heart disease and atrial septal defects.

摘要

目的

本研究旨在根据原发性心脏病变，描述功能性三尖瓣反流治疗的长期效果差异。

方法

对96例瓣膜性心脏病患者和32例合并三尖瓣反流的房间隔缺损患者进行了研究。三尖瓣环直径与右心衰竭证据相关。在瓣膜性心脏病中，33例三尖瓣环直径≥40 mm至44 mm的患者进行了Kay瓣环成形术，12例三尖瓣环直径≥45 mm至49 mm的患者进行了改良De Vega瓣环成形术，4例三尖瓣环直径≥50 mm的患者分别进行了改良De Vega瓣环成形术、使用Carpentier环的瓣环成形术或三尖瓣置换术。在房间隔缺损患者中，11例三尖瓣环直径≥45 mm至49 mm的患者进行了Kay瓣环成形术，5例三尖瓣环直径≥50 mm的患者进行了改良De Vega瓣环成形术。术后平均随访期为79个月。

结果

三尖瓣环直径<50 mm的患者，血流动力学和临床检查结果以及三尖瓣反流明显改善。然而，三尖瓣环直径≥50 mm的瓣膜性心脏病患者，右心参数也有改善，但与三尖瓣环直径<50 mm的患者相比改善程度较小。此外，4例接受改良De Vega瓣环成形术的患者术后晚期三尖瓣反流和临床表现逐渐增加。相比之下，所有5例三尖瓣环直径≥50 mm的房间隔缺损患者均显示出明显改善，与三尖瓣环直径<50 mm的患者相似。术前分析显示，房间隔缺损患者的右心功能恶化程度不如瓣膜性心脏病患者。