Menzel Thomas, Kramm Thorsten, Wagner Stephan, Mohr-Kahaly Susanne, Mayer Eckhard, Meyer Juergen
Department of Cardiology, Johannes Gutenberg-University, Mainz, Germany.
Ann Thorac Surg. 2002 Mar;73(3):756-61. doi: 10.1016/s0003-4975(01)03573-1.
For patients with chronic thromboembolic pulmonary hypertension who undergo pulmonary thromboendarterectomy (PTE) it has not yet been systematically investigated how operation affects the severity of tricuspid regurgitation (TR). This study sought (1) to evaluate the extent of TR reversibility after operation, (2) to identify potential predictors of the reversibility of TR, and (3) to investigate the influence of geometric and hemodynamic alterations on the extent of TR severity.
Thirty-nine patients (55+/-12 years) undergoing PTE without tricuspid valve repair were investigated before and 13+/-8 days after operation by Doppler color flow mapping. Geometry of the tricuspid valve as well as right ventricular size and function were determined with echocardiography. Mean pulmonary arterial pressure was determined invasively.
After PTE, mean pulmonary arterial pressure was significantly lower (48+/-10 versus 25+/-7 mm Hg, p < 0.05). Most of the patients had a distinct reduction of TR, and the improvement trend showed on the severity scale: number of patients with 4+TR (23 --> 4), 3+TR (12 --> 12), 2+TR (2 --> 13), and 1+TR (2 --> 10). Examination after PTE revealed profound reduction of right ventricular size and annulus diameter, with a normalization of the valvular geometry. However, none of the study variables were useful as indicators of the postoperative outcome.
After PTE without additional valve repair most patients show significantly reduced severity of TR soon afterward; the very few cases in which TR does not improve remain unidentifiable before operation. Our recommendation is consequently to refrain from additional tricuspid repair in patients undergoing PTE.
对于接受肺动脉血栓内膜剥脱术（PTE）的慢性血栓栓塞性肺动脉高压患者，手术如何影响三尖瓣反流（TR）的严重程度尚未得到系统研究。本研究旨在：（1）评估术后TR的可逆程度；（2）确定TR可逆性的潜在预测因素；（3）研究几何结构和血流动力学改变对TR严重程度的影响。
对39例（55±12岁）未行三尖瓣修复的PTE患者在术前及术后13±8天进行多普勒彩色血流成像检查。通过超声心动图确定三尖瓣的几何结构以及右心室大小和功能。有创测定平均肺动脉压。
PTE术后，平均肺动脉压显著降低（48±10 vs 25±7 mmHg，p<0.05）。大多数患者的TR明显减轻，严重程度分级显示改善趋势：4+级TR患者数量（23例→4例），3+级TR患者数量（12例→12例），2+级TR患者数量（2例→13例），1+级TR患者数量（2例→10例）。PTE术后检查显示右心室大小和瓣环直径显著减小，瓣膜几何结构恢复正常。然而，没有一个研究变量可作为术后结果的指标。
在未进行额外瓣膜修复的PTE术后，大多数患者的TR严重程度很快显著降低；术前无法识别TR未改善的极少数病例。因此，我们建议对接受PTE的患者避免进行额外的三尖瓣修复。
