Farid L, Dayem M K, Guindy R, Shabetai R, Dittrich H C
Division of Cardiology, University of California, San Diego.
Eur Heart J. 1992 Mar;13(3):366-72. doi: 10.1093/oxfordjournals.eurheartj.a060176.
A significant proportion of individuals with rheumatic disease have tricuspid valve involvement which may be clinically important and alter the medical or surgical approach to treatment. Therefore 50 patients with rheumatic left-sided valvular lesions who were referred for operative treatment were studied. Thirty patients had angiographically significant tricuspid regurgitation (group I) and 20 had a competent tricuspid valve (group II). Pre-operative cardiac assessment included Doppler echocardiography and contrast ventriculography. Patients with tricuspid regurgitation more commonly had mitral valve disease or combined mitral and aortic valve lesions, (P less than 0.001) and were more likely to have atrial fibrillation than those without tricuspid regurgitation (P less than 0.001). Pulmonary arterial systolic and mean right atrial pressures were higher in group I (both P less than 0.01). A close relationship was found between the angiographic and Doppler assessment of the degree of tricuspid regurgitation (P less than 0.01). Doppler-derived measurement of the right ventricular-right atrial systolic pressure difference correlated well with the systolic trans-tricuspid pressure difference measured at cardiac catheterization (y = 0.7x + 22, r = 0.67, P less than 0.001) and the pulmonary arterial systolic pressure (y = 0.8x + 27, r = 0.71, P less than 0.001). Rheumatic involvement of the tricuspid valve identified by pre-operative echocardiography was confirmed in five patients at surgery. Of the 13 patients with functional tricuspid regurgitation at operation, only two had been diagnosed as having organic disease by echocardiography. Furthermore, in all 18 cases where Doppler suggested grade 3 or 4+ tricuspid regurgitation, surgical repair or replacement of the valve was performed.(ABSTRACT TRUNCATED AT 250 WORDS)
相当一部分风湿性疾病患者存在三尖瓣受累情况，这在临床上可能具有重要意义，并会改变治疗的药物或手术方法。因此，对50例因风湿性左心瓣膜病变而接受手术治疗的患者进行了研究。30例患者存在血管造影显示的显著三尖瓣反流（第一组），20例患者三尖瓣功能正常（第二组）。术前心脏评估包括多普勒超声心动图和造影心室造影。与无三尖瓣反流的患者相比，三尖瓣反流患者更常患有二尖瓣疾病或二尖瓣和主动脉瓣联合病变（P<0.001），且更易发生心房颤动（P<0.001）。第一组的肺动脉收缩压和平均右心房压力更高（均P<0.01）。三尖瓣反流程度的血管造影和多普勒评估之间存在密切关系（P<0.01）。多普勒测量的右心室-右心房收缩压差与心导管检查时测量的收缩期跨三尖瓣压差相关性良好（y = 0.7x + 22，r = 0.67，P<0.001），与肺动脉收缩压也相关性良好（y = 0.8x + 27，r = 0.71，P<0.001）。术前超声心动图确定的三尖瓣风湿性受累在5例手术患者中得到证实。在手术中发现的13例功能性三尖瓣反流患者中，只有2例经超声心动图诊断为器质性疾病。此外，在所有18例多普勒提示3级或4+级三尖瓣反流的病例中，均进行了瓣膜手术修复或置换。（摘要截短于250字）
