Penther P, Boschat J, Etienne Y, Le Potier J, Gilard M
Service de cardiologie Lenégre, CHR Morvan, Brest, France.
Arch Mal Coeur Vaiss. 1988 Sep;81(9):1079-83.
In 194 cases of rheumatic cardiac valve diseases (41 men, 153 women), macroscopic examination singled out 21 lesions of the tricuspid valve (11 p. 100). These lesions were found exclusively in women and were always associated with a mitral valve disease (18 cases) or a mitral and aortic valve disease (3 cases). The fairly uncommon tricuspid valve lesions were of two different types, the incidence of which did not seem to be influenced by age. There were 7 cases of moderately tight (n = 5) or tight (n = 2) stenosis (TS) and 14 cases of tricuspid valve disease (TD), where a moderately tight stenosis coexisted with a varying degree of regurgitation (TR). In subjects with pure TS the three commissures were regularly fused by fibrosis, whereas the only lesion of the tricuspid leaflets was thickening of their free border. In TD the commissural fusions were less extensive, but the fibrous thickening was retractile and invaded the entire leaflet. The other anatomical data (perimeter of the tricuspid annulus, condition of the right cardiac cavities, heart weight, etc.) were approximately the same in both types. On anatomical specimens, percutaneous dilatation seemed possible only in pure TS; TD did not lend itself to this of treatment. In most cases two-dimensional echocardiography combined with doppler ultrasound can provide an accurate evaluation of the lesions from which can be deduced roughly the possibilities of percutaneous valvuloplasty limited to pure TS.
在194例风湿性心脏瓣膜病患者中（男性41例，女性153例），大体检查发现21例三尖瓣病变（占11%）。这些病变仅见于女性，且总是与二尖瓣病变（18例）或二尖瓣和主动脉瓣病变（3例）相关。相当罕见的三尖瓣病变有两种不同类型，其发病率似乎不受年龄影响。有7例为中度狭窄（n = 5）或重度狭窄（n = 2）（TS），14例为三尖瓣疾病（TD），其中中度狭窄并存不同程度的反流（TR）。在单纯TS患者中，三个瓣叶交界通常因纤维化而融合，而三尖瓣小叶唯一的病变是其游离缘增厚。在TD中，瓣叶交界融合范围较小，但纤维增厚可回缩并累及整个小叶。两种类型的其他解剖学数据（三尖瓣环周长、右心腔状况、心脏重量等）大致相同。在解剖标本上，经皮扩张似乎仅适用于单纯TS；TD不适合这种治疗方法。在大多数情况下，二维超声心动图结合多普勒超声可以对病变进行准确评估，从中大致可以推断出仅限于单纯TS的经皮瓣膜成形术的可能性。
