Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
J Thorac Cardiovasc Surg. 2011 Sep;142(3):608-13. doi: 10.1016/j.jtcvs.2010.10.042. Epub 2011 Feb 1.
It is not clear whether clinically silent tricuspid valve regurgitation should be addressed at the time of mitral valve repair for severe mitral regurgitation due to leaflet prolapse. We examined the clinical and echocardiographic outcomes of patients with tricuspid regurgitation who underwent only mitral valve repair.
We retrospectively analyzed records of patients undergoing mitral valve repair for isolated mitral valve prolapse who had coexistent tricuspid valve regurgitation during an 11-year period at our institution. Echocardiographic data were compared preoperatively, intraoperatively, and postoperatively at less than 1, 1 to 3, 3 to 5, and more than 5 years.
In 699 patients who underwent mitral valve repair for severe mitral regurgitation, mean age was 60.4 years and 459 (66%) were male. At the time of mitral valve repair, tricuspid valve regurgitation was grade 3 or more in 115 (16%) patients and less than grade 3 in 584 (84%) patients. After mitral valve repair, overall grade of tricuspid valve regurgitation decreased significantly within the first year (P = .01). In patients with grade 3 regurgitation or more, the grade decreased at dismissal and until the third year (P < .001). Female sex, preoperative atrial fibrillation, and diabetes mellitus were independent risk factors for increased tricuspid valve regurgitation with time; preoperative regurgitation of grade 3 or more independently predicted decreased grade with time. Only 1 patient required tricuspid reoperation 4.5 years after mitral repair.
Clinically silent nonsevere tricuspid valve regurgitation in patients with degenerative mitral valve disease is unlikely to progress after mitral valve repair. Tricuspid valve surgery is rarely necessary for most patients undergoing repair of isolated mitral valve prolapse.
对于因瓣叶脱垂导致的重度二尖瓣反流，在二尖瓣修复时是否应处理临床上无症状的三尖瓣反流尚不清楚。我们研究了仅行二尖瓣修复的三尖瓣反流患者的临床和超声心动图结局。
我们回顾性分析了在我院 11 年间因孤立性二尖瓣脱垂行二尖瓣修复术且术中并存三尖瓣反流的患者的病历记录。比较了术前、术中及术后 1 年以内、1 至 3 年、3 至 5 年和 5 年以上的超声心动图数据。
在 699 例行重度二尖瓣反流二尖瓣修复术的患者中，平均年龄为 60.4 岁，459 例（66%）为男性。在二尖瓣修复时，115 例（16%）患者的三尖瓣反流程度为 3 级或更高级别，584 例（84%）患者的反流程度低于 3 级。二尖瓣修复后，一年内三尖瓣反流整体严重程度显著降低（P =.01）。在反流程度为 3 级或更高级别的患者中，反流程度在出院时和第 3 年时降低（P <.001）。女性、术前房颤和糖尿病是三尖瓣反流随时间进展的独立危险因素；术前反流程度为 3 级或更高级别独立预测随时间反流程度降低。仅有 1 例患者在二尖瓣修复后 4.5 年时需行三尖瓣再次手术。
在退行性二尖瓣病变患者中，临床上无症状的非重度三尖瓣反流在二尖瓣修复后不太可能进展。对于大多数行孤立性二尖瓣脱垂修复的患者，很少需要行三尖瓣手术。
