Hannoush Hwaida, Fawzy Mohamed Eid, Stefadouros Miltiadis, Moursi Mohamed, Chaudhary Mohammad A, Dunn Bruce
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Am Heart J. 2004 Nov;148(5):865-70. doi: 10.1016/j.ahj.2004.05.017.
Significant tricuspid regurgitation (TR) is occasionally associated with severe mitral stenosis and has an adverse impact on morbidity and mortality in patients undergoing mitral valve surgery. However, the effect of successful mitral balloon valvotomy (MBV) on significant TR is not fully elucidated. The aim of this study was to investigate TR after MBV in patients with severe mitral stenosis.
We analyzed the data of 53 patients with significant TR (grade > or =2, on a 1 to 3 scale) from the mitral balloon valvotomy database at our hospital. Patients were evaluated by Doppler echocardiography before valvotomy and at follow-up 1 to 13 years after MBV. Patients were divided into group A (27 patients), in whom TR regressed by > or =1 scale, and group B (26 patients), in whom TR did not regress.
The Doppler-determined pulmonary artery systolic pressure was initially higher and decreased at follow-up more in group A (from 70.7 +/- 23.8 to 36.5 +/- 8.3 mm Hg; P < .0001) than in group B (from 48.7 +/- 17.8 to 41.6 +/- 13.1 mm Hg; P = NS). Compared with patients in group B, patients in group A were younger (25 +/-10 vs 35 +/- 11 years; P < .005), had higher prevalence of functional TR (85% vs 8%; P < .0001), and had lower incidence of atrial fibrillation (7% vs 38%; P < .005). Significant decrease in right ventricular end-diastolic dimension after MBV was noted in group A but not in group B. The mitral valve area at late follow-up was larger in group A than in group B (1.8 +/- 0.3 vs 1.6 +/- 0.3 cm2; P < .05).
Regression of significant TR after successful MBV in patients with severe mitral stenosis was observed in patients who had severe pulmonary hypertension. This improvement in TR occurred even in the presence of organic tricuspid valve disease.
严重三尖瓣反流（TR）偶尔与重度二尖瓣狭窄相关，对接受二尖瓣手术患者的发病率和死亡率有不利影响。然而，成功的二尖瓣球囊瓣膜成形术（MBV）对严重TR的影响尚未完全阐明。本研究的目的是调查重度二尖瓣狭窄患者MBV术后的TR情况。
我们分析了我院二尖瓣球囊瓣膜成形术数据库中53例严重TR（分级≥2级，1至3级评分）患者的数据。在瓣膜成形术前及MBV术后1至13年的随访中，通过多普勒超声心动图对患者进行评估。患者被分为A组（27例），其TR减轻≥1级；B组（26例），其TR未减轻。
A组多普勒测定的肺动脉收缩压最初较高，随访时下降幅度更大（从70.7±23.8降至36.5±8.3 mmHg；P<.0001），高于B组（从48.7±17.8降至41.6±13.1 mmHg；P=无显著性差异）。与B组患者相比，A组患者更年轻（25±10岁对35±11岁；P<.005），功能性TR患病率更高（85%对8%；P<.0001），房颤发生率更低（7%对38%；P<.005）。MBV术后A组右心室舒张末期内径显著减小，而B组未减小。A组晚期随访时二尖瓣瓣口面积大于B组（1.8±0.3对1.6±0.3 cm²；P<.05）。
重度二尖瓣狭窄患者成功MBV后，重度TR在重度肺动脉高压患者中出现减轻。即使存在器质性三尖瓣疾病，TR也有改善。
