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获得性三尖瓣疾病的外科治疗——三尖瓣环成形术(德维加法)与三尖瓣置换术的效果及比较

[Surgical management of acquired tricuspid valve disease--the effects and comparison of tricuspid annuloplasty (De Vega) and tricuspid valve replacement].

作者信息

Abe T, Morikawa M, Tsukamoto M, Watanabe N, Kazui T, Komatsu S

出版信息

Kokyu To Junkan. 1989 Jul;37(7):757-63.

PMID:2799095
Abstract

A total of 92 patients with tricuspid valvular disease (TR) had surgical repair of DeVega's annuloplasty in 80 patients (87%) and of valve replacement in 12 patients (13%) from January, 1978, to March, 1988. All of those patients were diagnosed by cardiac catheterization and angiogram, clinical findings and in recent cases, pulsed and color Doppler echocardiography were applied. Eighty-nine of 92 patients (97%) were in NYHA class III or IV before operation. There were 7 early death (8.5%) with DeVega procedure and one death (8.3%) in TVR and late deaths were noted in 3 patients (3.6%) (DeVega's procedure) and one (8.3%) in TVR. Two patients after DeVega procedure at 5 and 6 years were required re-operation of TVR because of recurrent mitral valvular disease. Seventy-seven of 80 survivors were in NYHA class I or II postoperatively. Twenty-seven randomized selected patients after DeVega's annuloplasty were investigated by pulsed and color Doppler echocardiography, 17 of them (63%) had no regurgitation and the remaining 10 patient had mild to moderate regurgitation. This study suggests that DeVega's annuloplasty has a simple and reliable procedure in patients with functional TR and results in excellent hemodynamic and functional effects postoperatively.

摘要

1978年1月至1988年3月期间,共有92例三尖瓣疾病(TR)患者接受手术治疗,其中80例(87%)患者进行了德维加瓣环成形术修复,12例(13%)患者进行了瓣膜置换术。所有这些患者均通过心导管检查和血管造影、临床检查确诊,近期病例还应用了脉冲和彩色多普勒超声心动图检查。92例患者中有89例(97%)术前处于纽约心脏协会(NYHA)心功能分级III或IV级。德维加手术有7例早期死亡(8.5%),三尖瓣置换术有1例死亡(8.3%),德维加手术有3例(3.6%)出现晚期死亡,三尖瓣置换术有1例(8.3%)出现晚期死亡。2例接受德维加手术后5年和6年的患者因二尖瓣疾病复发需要再次进行三尖瓣置换术。80例幸存者中有77例术后处于NYHA心功能分级I或II级。对27例随机选择的接受德维加瓣环成形术的患者进行了脉冲和彩色多普勒超声心动图检查,其中17例(63%)无反流,其余10例患者有轻度至中度反流。本研究表明,德维加瓣环成形术对于功能性TR患者而言是一种简单可靠的手术方法,术后具有良好的血流动力学和功能效果。

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