Minale C, Lambertz H, Messmer B J
Department of Thoracic and Cardiovascular Surgery, University Hospital of R.W.T.H. Aachen, Federal Republic of Germany.
J Thorac Cardiovasc Surg. 1987 Oct;94(4):626-31.
Four patients with multivalvular disease underwent tricuspid valve repair by a new technique. The anterior and posterior leaflets adjacent to the incompetent commissure were separated from the anulus to allow coaptation of the three leaflets in the middle. In conjunction with the commissure, half of the isolated anulus was then excluded with a continuous 3-0 Ti-Cron suture. A 5-0 Prolene suture was then used to readapt the cut edges of the leaflets to the shortened anulus. In this way it was possible to reduce the circumference of the anulus selectively, without reducing the active area of the leaflets. All patients survived. A significant decrease in the mean right atrial pressure without evidence of regurgitation could be recorded in all patients. Postoperative morphometric echocardiographic evaluation of the tricuspid valve showed a maximal anulus diameter even larger than in normal hearts. No inflow obstruction was present. The systolic shortening of the anulus ranged within normal limits. The opening amplitude of the leaflet as well as the slope of the ejection fraction were not decreased. No significant regurgitation was evidenced by contrast echocardiograms. One to 3 months postoperatively, no annuloplasty dehiscence has occurred.
4例多瓣膜病患者采用新技术进行了三尖瓣修复。将与功能不全瓣叶交界相邻的前叶和后叶与瓣环分离，以使三个瓣叶在中间贴合。然后用连续的3-0钛制Cron缝线将分离的瓣环的一半与交界一起排除。接着用5-0聚丙烯缝线将瓣叶的切缘重新贴合到缩短的瓣环上。通过这种方式，可以选择性地减小瓣环周长，而不减小瓣叶的有效面积。所有患者均存活。所有患者均记录到平均右心房压力显著降低且无反流证据。术后三尖瓣形态学超声心动图评估显示最大瓣环直径甚至大于正常心脏。无流入道梗阻。瓣环的收缩期缩短在正常范围内。瓣叶的开放幅度以及射血分数斜率均未降低。对比超声心动图未显示明显反流。术后1至3个月，未发生瓣环成形术裂开。
