Goksin Ibrahim, Yilmaz Arif, Baltalarli Ahmet, Goktogan Tayfun, Karahan Nagihan, Turk Ufuk Ali, Kara Hakan, Sagban Mansur
Cardiovascular Surgery Department, Heart Center, Pamukkale University Hospital, Denizli, Turkey.
J Card Surg. 2006 Mar-Apr;21(2):172-5. doi: 10.1111/j.1540-8191.2006.00203.x.
De Vega annuloplasty is one of the most effective methods used in surgical correction of functional tricuspid regurgitation (FTR). Physiologic annular motions are protected by De Vega annuloplasty. However, recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon may be seen after De Vega annuloplasty as a result of gliding (jiggle) effect. The aim of this new annuloplasty was to prevent Bowstring phenomenon seen in De Vega annuloplasty.
Twenty-five patients with severe FTR secondary to the left-sided valvular heart disease were included in this study. Modified semicircular constricting annuloplasty (Sagban's annuloplasty): The procedure is performed utilizing 0 and 2-0 polypropylene sutures. At first, 0 and 2-0 polypropylene sutures are fixed and knotted at anteroseptal and posteroseptal comissural regions (named as anchoring points). 2-0 Polypropylene sutures which come from anchoring points in clockwise and counterclockwise direction are used to encircle the free wall annulus as well as 0 polypropylene sutures in spiral fashion (spiral annulary suture technique). When both sutures get to the anteroposterior comissural region (tying point), they are passed through plastic snares. After the annuloplasty is completed, with the heart beating and the pulmonary artery clamped, competency of the valve is tested by injecting saline into the right ventricular chamber before the adjusting suture is tied. In this annuloplasty, 0 polypropylene sutures are used for reduction and constriction, 2-0 polypropylene sutures are used for the fixation of 0 polypropylene sutures in annular level.
FTR improved totally in 16 patients (66.7%), 4 patients (16.7%) had first degree, 3 patients (12.5%) had second degree, and only 1 patient (4.2%) had third degree residual tricuspid regurgitation in an average follow-up period of 17.8 months. One patient died from low cardiac output in early postoperative period.
There is no risk of recurrent regurgitation secondary to Bowstring phenomenon in this alternative annuloplasty technique and this annuloplasty is cost-effective and performed easily.
德维加瓣环成形术是外科矫正功能性三尖瓣反流（FTR）最有效的方法之一。德维加瓣环成形术可保护生理性瓣环运动。然而，由于滑动（抖动）效应，德维加瓣环成形术后可能会出现继发于弓弦（吉他弦）现象的复发性三尖瓣反流。这种新的瓣环成形术的目的是预防德维加瓣环成形术中出现的弓弦现象。
本研究纳入了25例继发于左侧瓣膜性心脏病的重度FTR患者。改良半圆形缩窄瓣环成形术（萨班瓣环成形术）：该手术使用0号和2-0号聚丙烯缝线进行。首先，将0号和2-0号聚丙烯缝线在前后间隔和后间隔连合区域（称为锚定部位）固定并打结。来自锚定部位的2-0号聚丙烯缝线沿顺时针和逆时针方向用于环绕游离壁瓣环，同时0号聚丙烯缝线以螺旋方式（螺旋瓣环缝合技术）进行。当两根缝线到达前后连合区域（打结部位）时，将它们穿过塑料圈套。瓣环成形术完成后，在心脏跳动且肺动脉夹闭的情况下，在收紧缝线之前，通过向右心室腔注射生理盐水来测试瓣膜的功能。在这种瓣环成形术中，0号聚丙烯缝线用于缩小和缩窄，2-0号聚丙烯缝线用于将0号聚丙烯缝线固定在瓣环水平。
在平均17.8个月的随访期内，16例患者（66.7%）的FTR完全改善，4例患者（16.7%）有一度反流，3例患者（12.5%）有二度反流，只有1例患者（4.2%）有三度残余三尖瓣反流。1例患者在术后早期因低心输出量死亡。
这种替代性瓣环成形术技术不存在继发于弓弦现象的复发性反流风险，且这种瓣环成形术具有成本效益且操作简便。
