De Bonis Michele, Lapenna Elisabetta, La Canna Giovanni, Grimaldi Antonio, Maisano Francesco, Torracca Lucia, Caldarola Alessandro, Alfieri Ottavio
Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy.
Eur J Cardiothorac Surg. 2004 May;25(5):760-5. doi: 10.1016/j.ejcts.2004.01.051.
Correction of tricuspid regurgitation due to complex lesions (not treatable with annuloplasty only) is associated with suboptimal results. To improve the efficacy of valve repair in this context, we developed a new surgical approach, which consists of stitching together the central part of the free edges of the leaflets producing a 'clover' shaped valve. Our preliminary experience with this novel technique is reported.
Between 2001 and 2003, 14 patients (mean age 57+/-17 years), with severe tricuspid regurgitation due to complex lesions, underwent valve repair with this novel approach in combination with annuloplasty. The aetiology of the disease was post-traumatic in five cases, degenerative in eight and secondary to dilated cardiomyopathy in one. Anterior leaflet prolapse/flail was present in most patients associated with posterior and/or septal leaflet prolapse or tethering. Annular and right ventricular dilatation was present in all cases. Mitral valve repair/replacement was concomitantly performed in nine patients.
Hospital mortality was 7.1% (1/14). At follow-up extending to 22 months (mean 12+/-6.3), all survivors were asymptomatic. At the last echocardiogram tricuspid regurgitation was absent or mild in 13 patients and moderate in one. Mean tricuspid valve area and gradient were 4.2+/-0.4 cm(2) and 2.7+/-1.4 mmHg, respectively.
Despite the short follow-up, this novel technique appears to be an easy, rapid and effective approach to correct severe tricuspid regurgitation due to complex lesions. Such a repair restored tricuspid valve competence, even in the presence of huge RV dilatation and pulmonary hypertension.
因复杂病变导致的三尖瓣反流（仅行瓣环成形术无法治疗）矫正术后效果欠佳。为提高此类情况下瓣膜修复的疗效，我们研发了一种新的手术方法，即将瓣叶游离缘的中央部分缝合在一起，形成一个“三叶草”形瓣膜。本文报告了我们应用这种新技术的初步经验。
2001年至2003年间，14例（平均年龄57±17岁）因复杂病变导致严重三尖瓣反流的患者接受了这种新方法联合瓣环成形术的瓣膜修复手术。病因方面，创伤后5例，退行性变8例，继发于扩张型心肌病1例。大多数患者存在前叶脱垂/连枷样病变，并伴有后叶和/或隔叶脱垂或缩短。所有病例均存在瓣环和右心室扩张。9例患者同时进行了二尖瓣修复/置换术。
住院死亡率为7.1%（1/14）。随访至22个月（平均12±6.3个月），所有存活患者均无症状。在最后一次超声心动图检查时，13例患者三尖瓣反流消失或轻度，1例为中度。三尖瓣平均瓣口面积和压差分别为4.2±0.4 cm²和2.7±1.4 mmHg。
尽管随访时间较短，但这种新技术似乎是一种简单、快速且有效的方法，可用于矫正因复杂病变导致的严重三尖瓣反流。即使存在巨大的右心室扩张和肺动脉高压，这种修复方法也能恢复三尖瓣功能。
