Hou Xiao-Tong, Meng Xu, Zhou Qi-Wen, Zhang Jian-Qun, Xu Chun-Lei, Wang Jian-Gang
Department of Cardiac Surgery, Anzhen Hospital, Capital University of Medical Science, Beijing 100029, China.
Chin J Traumatol. 2006 Apr;9(2):91-3.
To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency.
From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years median: 38 years, mean: (38.5 +/- 18.1) years. The intervals between trauma and operation ranged from 1 month to 20 years median: 19 months, mean: (52.5 +/- 80.3) months). In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes II-IV. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients.
No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months median: 39 months, mean: (53.4 +/- 42.8) months, all patients were classified as NYHA class I, without any changes.
The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.
探讨创伤性三尖瓣关闭不全的最佳手术治疗时机及手术方法。
1984年5月至2004年9月，8例患者接受了创伤性三尖瓣关闭不全手术。所有患者均为男性，年龄7至67岁，中位数：38岁，平均：（38.5±18.1）岁。受伤至手术的间隔时间为1个月至20年，中位数：19个月，平均：（52.5±80.3）个月。7例患者的三尖瓣关闭不全归因于钝性胸部创伤，其中3例为车祸伤，另1例为刺伤。经超声心动图确诊。患者术前心功能分级为纽约心脏协会（NYHA）Ⅱ - Ⅳ级。手术中，所有患者均因腱索断裂导致三尖瓣前叶完全或部分脱垂。1例患者发现隔叶腱索断裂。2例患者前叶穿孔。2例患者隔叶回缩并粘连于心室间隔。所有患者均打算进行瓣膜修复。最终，3例患者成功进行了瓣膜修复，5例患者进行了三尖瓣置换。
无早期或晚期死亡发生。通过临床表现和超声心动图随访7至129个月，中位数：39个月，平均：（53.4±42.8）个月，所有患者均为NYHAⅠ级，无任何变化。
手术治疗可获得创伤性三尖瓣关闭不全的满意疗效。早期手术可能增加三尖瓣修复的可行性并防止右心室功能恶化。
