Uchida T, Sasako Y, Kobayashi J, Bando K, Minatoya K, Inamori S, Hayashi T, Nagasawa T, Kitamura S
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Kyobu Geka. 2001 Feb;54(2):132-5.
A successful case with liver cirrhosis underwent re-tricuspid valve replacement (TVR) using right heart bypass is reported herein. A 59-year-old lady previously undergone tricuspid valve replacement with bioprosthetic valve had suffered from exertional fatigue as the feature of congestive heart failure. She also presented severe liver dysfunction owing to chronic hepatitis and cardiac liver cirrhosis. She was diagnosed with structural deterioration of bioprosthesis in tricuspid position. She underwent re-TVR with right heart bypass consisted of centrifugal pump, heparin coating circuit and blood reservoir. This system lacked of membranous oxygenator in order not to activate various kinds of chemical mediator which leads to postoperative liver dysfunction. Postoperative course was uneventful and she is doing well 1 year after the operation. Although the mortality of the TVR in the patient with cirrhosis remains still high, this new technique seems to provide better outcome in this kind of patients.
本文报道了一例成功的肝硬化患者采用右心旁路进行再次三尖瓣置换（TVR）的病例。一名59岁女性曾接受生物瓣三尖瓣置换术，现出现劳力性疲劳，这是充血性心力衰竭的特征。她还因慢性肝炎和心源性肝硬化出现严重肝功能障碍。她被诊断为三尖瓣位生物瓣结构恶化。她接受了由离心泵、肝素涂层回路和储血器组成的右心旁路再次TVR。该系统没有膜式氧合器，以免激活各种导致术后肝功能障碍的化学介质。术后过程顺利，术后1年她情况良好。尽管肝硬化患者进行TVR的死亡率仍然很高，但这项新技术似乎能为此类患者带来更好的预后。
