Yang Xiu-bin, Wu Qing-yu, Xu Jian-ping, Shen Xiang-dong, Gao Shuang, Liu Feng, Liu Xiao-yan
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2006 Nov 15;44(22):1565-7.
To explore the approach and the result in tricuspid valve insufficiency treatment by a cusp remodeling technique.
Nine patients with severe tricuspid regurgitation, congenital lack of chordae in 6 cases and traumatic rupture of chordae in 3 cases, underwent surgical repair between April 1997 and March 2006. There were six male and three female. Their ages ranged from 8 years to 57 years. One or two segments of flail leaflets were presented in these patients. Valve repair was performed by suture of the free edge of the affected cusp segment, plication of the segment of annulus devoid of leaflet, and fixation of the neo-annulus with a flexible annuloplasty ring.
All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in six patients and a mild residual tricuspid regurgitation in three. A remarkable decrease in the diameter of the right ventricle (anterior to posterior) was observed: from mean (43.6 +/- 4.2) mm (range 29 mm to 64 mm) preoperatively reducing to mean (24.0 +/- 1.8) mm (range 16 mm to 32 mm) postoperatively. All patients are doing well in 1 month to 109 months follow up.
The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae.
探讨采用瓣叶重塑技术治疗三尖瓣关闭不全的方法及效果。
1997年4月至2006年3月，对9例严重三尖瓣反流患者进行手术修复，其中6例为先天性腱索缺如，3例为外伤性腱索断裂。男性6例，女性3例。年龄8岁至57岁。这些患者均存在一或两个瓣叶脱垂节段。手术通过缝合受累瓣叶节段的游离缘、折叠无瓣叶附着的瓣环节段以及用柔性瓣环成形环固定新瓣环来进行瓣膜修复。
所有患者术后均存活并康复。超声心动图显示，6例患者瓣叶对合良好，三尖瓣无反流；3例有轻度三尖瓣残余反流。右心室前后径明显减小：术前平均（43.6±4.2）mm（范围29 mm至64 mm），术后降至平均（24.0±1.8）mm（范围16 mm至32 mm）。在1个月至109个月的随访中，所有患者情况良好。
该手术为先天性腱索缺如或外伤性腱索断裂所致三尖瓣瓣叶脱垂的修复提供了一种简单且有价值的选择。
