Zhen Yanan, Zhang Jianbin, Liu Xiaopeng, Sun Guang, Zheng Xia, Han Yongxin, Zhai Zhenguo, Li Aili, Lin Fan, Liu Peng
Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Department of Respiratory and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China.
J Thorac Dis. 2020 Mar;12(3):758-764. doi: 10.21037/jtd.2019.12.99.
For patients with chronic thromboembolic pulmonary hypertension (CTEPH) and tricuspid regurgitation (TR) undergoing pulmonary thromboendarterectomy (PTE), whether concomitant tricuspid annuloplasty should be carried out is still controversial.
The study population consisted of 45 consecutive patients with CTEPH who were scheduled to undergo PTE. All PTE surgeries were conducted with a median sternotomy and deep hypothermia circulatory arrest (DHCA). We collected and analyzed the demographics, surgical details, echocardiographic parameters, and right heart catheterization (RHC) results of these patients.
Moderate to severe TR was documented in 48.9% (22/45) of the patients pre-operatively and 4.4% (2/45) of the patients post-operatively. In patients with grade 4 TR, severity decreased to grade 2 in 8 and to grade 1 in 1. In patients with grade 3 TR, severity decreased to grade 2 in 9, to grade 1 in 3, and 1 remained unchanged. In patients with grade 2 TR, severity decreased to grade 1 in 8, and 15 remained unchanged. The post-operative TR velocity was decreased significantly (431.9±53.4 196.5±154.0, P<0.001). Pulmonary artery systolic pressure was 84±17 mmHg pre-operatively and decreased to 38±14 mmHg post-operatively (P<0.001). The pre and post-operative pulmonary diastolic pressure was 29±9 and 17±7 mmHg, respectively (P<0.001). The pre and post-operative mean pulmonary pressure was 48±10 and 24±9 mmHg, respectively (P<0.001). The pulmonary vascular resistance (PVR) (1,025.4±465.0 476.6±181.2 dynes·sec·cm, P<0.001) and pulmonary artery wedge pressure (PAWP) (9±4 5±2 mmHg, P<0.001) decreased significantly after operation. The cardiac index (CI) increased significantly (1.9±0.5 2.3±0.4, P=0.003) after operation.
In conclusion, functional TR could be alleviated after PTE even in patients with high PVR. However, the long-term results need to be further investigated.
对于接受肺动脉血栓内膜剥脱术（PTE）的慢性血栓栓塞性肺动脉高压（CTEPH）和三尖瓣反流（TR）患者，是否应同时进行三尖瓣环成形术仍存在争议。
研究人群包括45例连续计划接受PTE的CTEPH患者。所有PTE手术均采用正中胸骨切开术和深低温停循环（DHCA）。我们收集并分析了这些患者的人口统计学资料、手术细节、超声心动图参数和右心导管检查（RHC）结果。
术前48.9%（22/45）的患者记录有中度至重度TR，术后4.4%（2/45）的患者有该情况。在4级TR患者中，8例严重程度降至2级，1例降至1级。在3级TR患者中，9例严重程度降至2级，3例降至1级，1例不变。在2级TR患者中，8例严重程度降至1级，15例不变。术后TR速度显著降低（431.9±53.4对196.5±154.0，P<0.001）。术前肺动脉收缩压为84±17 mmHg，术后降至38±14 mmHg（P<0.001）。术前和术后肺动脉舒张压分别为29±9和17±7 mmHg（P<0.001）。术前和术后平均肺动脉压分别为48±10和24±9 mmHg（P<0.001）。术后肺血管阻力（PVR）（1,025.4±465.0对476.6±181.2达因·秒·厘米，P<0.001）和肺动脉楔压（PAWP）（9±4对5±2 mmHg，P<0.001）显著降低。术后心脏指数（CI）显著升高（1.9±0.5对2.3±0.4，P=0.003）。
总之，即使在高PVR患者中，PTE术后功能性TR也可得到缓解。然而，长期结果需要进一步研究。
