Department of Cardiovascular Surgery, Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China.
Ann Thorac Surg. 2010 Dec;90(6):1934-8. doi: 10.1016/j.athoracsur.2010.07.081.
Traumatic tricuspid insufficiency (TTI) is uncommon and surgical experience is limited. We report our surgical experience with TTI in 13 patients.
From January 2000 through March 2008, we operated on 13 patients with TTI (10 men 3 women; mean age, 39.8 ± 10.5 years). The intervals from trauma to diagnosis and from trauma to surgery averaged 37.4 and 54.4 months, respectively. At operation, the mechanism of TTI was due to anterior chordal rupture in 8, anterior papillary muscle rupture in 3, rupture of anterior papillary muscle and chordae in 1, and anterior leaflet defect in 1. In 7 patients the annulus was dilated. Valve repair was successful in 13 patients.
No early or late deaths occurred. Severe hemolysis occurred in 1 patient after tricuspid and mitral valve repairs. At follow-up extending to 9.5 years, 9 patients were in New York Heart Association functional class I, and 4 were in class II. Transthoracic echocardiography demonstrated no or trivial residual regurgitation in 7 patients, mild regurgitation in 4, and mild-to-moderate regurgitation in 2. A significant decrease of the right ventricular end-diastolic dimension (37.7 ± 9.7 vs 20.7 ± 4.6 mm; p < 0.001) was observed. The mean transvalvular gradient was 2.5 ± 0.8 mm Hg. Eleven patients were in sinus rhythm.
Satisfactory early and midterm outcomes can be achieved for TTI by tricuspid valve repair. Early surgical intervention should be emphasized to achieve good functional results and preserve the right ventricular function.
创伤性三尖瓣关闭不全（TTI）并不常见，手术经验有限。我们报告了 13 例 TTI 患者的手术经验。
从 2000 年 1 月至 2008 年 3 月，我们对 13 例 TTI 患者（男 10 例，女 3 例；平均年龄 39.8±10.5 岁）进行了手术。从创伤到诊断和从创伤到手术的平均间隔分别为 37.4 个月和 54.4 个月。在手术中，TTI 的机制是由于 8 例前索断裂、3 例前乳头肌断裂、1 例前乳头肌和索断裂以及 1 例前瓣缺损。7 例患者瓣环扩张。13 例患者成功进行了瓣膜修复。
无早期或晚期死亡。1 例患者在三尖瓣和二尖瓣修复后发生严重溶血。随访 9.5 年，9 例患者纽约心脏协会功能分级为 I 级，4 例为 II 级。7 例患者经胸超声心动图显示无或轻微残余反流，4 例患者轻度反流，2 例患者轻度至中度反流。右心室舒张末期内径显著减小（37.7±9.7 比 20.7±4.6mm；p<0.001）。跨瓣压差平均为 2.5±0.8mmHg。11 例患者为窦性心律。
通过三尖瓣修复可以获得满意的早期和中期 TTI 结果。应强调早期手术干预，以获得良好的功能结果并保留右心室功能。
