Klutstein Marc, Balkin Jonathan, Butnaru Adi, Ilan Michael, Lahad Amnon, Rosenmann David
Shaare Zedek Medical Center, Jerusalem, Israel, affiliated with Hebrew University of Jerusalem, Israel.
Pacing Clin Electrophysiol. 2009 Mar;32 Suppl 1:S135-7. doi: 10.1111/j.1540-8159.2008.02269.x.
Severe tricuspid insufficiency (TI) after permanent pacemaker implantation (PPI) has been described in small series of patients, though its incidence is not known.
We retrospectively analyzed the data of 545 patients who underwent PPI and had Doppler echocardiograms performed before and after the procedure. We excluded 135 patients who had > or =moderate TI on the 1st Doppler echocardiogram.
Group 1 included 75 patients (18.3%) who had a >2 grades worsening of TI, and group 2 included 335 patients (82%) with <2 grade increase in TI after PPI. Patients in group 1 were 77 +/- 7 years of age, versus 72 +/- 10 years in group 2 (P < 0.001). There was no difference in left ventricular size and function. The TI gradient before PPI was higher in group 2 (25 +/- 13 mmHg versus 19 +/- 12 mmHg [P < 0.001]), though within the normal range in both groups. The mitral E/A ratio was 0.98 in group 1 versus 1.42 in group 2 (P < 0.001). The systolic TI gradient after implantation was 42 +/- 12 mmHg in group 1, versus 33 +/- 8 mmHg in group 2 (P < 0.001).
Worsening of TI after PPI was not rare and was observed more often in older patients, with abnormal LV relaxation and who developed pulmonary hypertension after the procedure.
尽管永久性起搏器植入（PPI）后严重三尖瓣关闭不全（TI）的发生率尚不清楚，但已有少量患者系列报道。
我们回顾性分析了545例行PPI并在术前和术后进行多普勒超声心动图检查的患者数据。我们排除了135例首次多普勒超声心动图显示有≥中度TI的患者。
第1组包括75例（18.3%）TI恶化超过2级的患者，第2组包括335例（82%）PPI后TI增加<2级的患者。第1组患者年龄为77±7岁，第2组为72±10岁（P<0.001）。左心室大小和功能无差异。PPI前第2组的TI压差较高（25±13mmHg对19±12mmHg[P<0.001]），尽管两组均在正常范围内。第1组二尖瓣E/A比值为0.98，第2组为1.42（P<0.001）。植入后第1组的收缩期TI压差为42±12mmHg，第2组为33±8mmHg（P<0.001）。
PPI后TI恶化并不少见，在老年患者、左心室舒张功能异常以及术后发生肺动脉高压的患者中更常观察到。
