感染性心内膜炎的复杂三尖瓣修复：瓣叶扩大、腱索和瓣环重建。

Complex tricuspid valve repair for infective endocarditis: leaflet augmentation, chordae and annular reconstruction.

作者信息

Tarola Christopher L, Losenno Katie L, Chu Michael W A

机构信息

Division of Cardiac Surgery, Western University, London, ON, Canada.

Division of Cardiac Surgery, Western University, London, ON, Canada

出版信息

Multimed Man Cardiothorac Surg. 2015 May 19;2015. doi: 10.1093/mmcts/mmv006. Print 2015.

DOI:10.1093/mmcts/mmv006

PMID:25989809

Abstract

Surgical treatment of tricuspid valve (TV) endocarditis remains a challenge because of extensive valve destruction, high risk of reinfection, poor outcomes with valve replacement and complex patient compliance issues. Reconstruction of the TV is certainly favoured over replacement; however, diffuse, multifocal vegetations and complete debridement often leave insufficient building materials necessary for repair. We describe our surgical reconstructive technique that relies upon extensive autologous pericardial patch augmentation of the destroyed TV leaflets to establish leaflet coaptation, supplemented with expanded polytetrafluoroethylene neo-chordae and annular reconstruction. We report our outcomes in a series of patients with grossly infected TVs with more than 50% of valvular destruction.

摘要

三尖瓣（TV）心内膜炎的外科治疗仍然是一项挑战，这是由于瓣膜广泛破坏、再感染风险高、瓣膜置换预后不佳以及患者依从性复杂问题。与置换相比，三尖瓣重建当然更受青睐；然而，弥漫性、多灶性赘生物和彻底清创常常导致修复所需的构建材料不足。我们描述了我们的外科重建技术，该技术依靠对受损的三尖瓣小叶进行广泛的自体心包补片增强来实现小叶贴合，并辅以膨体聚四氟乙烯人工腱索和瓣环重建。我们报告了一系列瓣膜严重感染且瓣膜破坏超过50%的患者的治疗结果。