Yamamoto Yusuke, Nomura Koji, Murayama Fumiaki, Isobe Sho, Hoshino Kenji
Department of Pediatric Cardiovascular Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu-city, Tokyo, 183-8561, Japan.
Department of Pediatric Cardiovascular Surgery, Saitama Children's Medical Center, 1-2 Shintoshin, Saitama-city, Saitama, 330-8777, Japan.
Pediatr Cardiol. 2021 Dec;42(8):1854-1861. doi: 10.1007/s00246-021-02679-x. Epub 2021 Jul 13.
Although De Vega annuloplasty is an important option for pediatric patients with functional tricuspid regurgitation (TR), little is known about its long-term results, including the future of the plicated annulus. We retrospectively reviewed our experience with pediatric patients who underwent the De Vega annuloplasty between 2005 and 2020. Tricuspid valve assessments were performed by transthoracic echocardiography. The targeted diameter of annular plication was 80 to 90% of normal tricuspid diameter, according to the patient's condition. The study included 55 patients (41 with biventricular physiology (group B), 14 with univentricular physiology (group U)) with a median follow-up of 5.0 years. Median age at operation was 5.0 years. There was one late death due to severe mitral regurgitation. Tricuspid valve reoperation was required in five patients and the 10-year freedom from reoperation was 91.9% for the entire cohort. The 10-year freedom from the composite adverse outcome of death, reoperation, and significant TR was 79.2% in group B versus 56.6% in group U (p = 0.034). TR grade significantly decreased after surgery (p < 0.001), without significant aggravation during the postoperative follow-up. No patients presented tricuspid stenosis. Mean Z-scores of annular diameter immediately after operation and at the latest follow-up were - 0.65 ± 0.56 versus - 0.47 ± 0.65 (p = 0.57). De Vega annuloplasty is a safe, efficient, and durable procedure for functional TR in pediatric patients including those with univentricular physiology, allowing adequate growth of the plicated annulus without the progression of tricuspid stenosis.
尽管德维加瓣环成形术是功能性三尖瓣反流（TR）小儿患者的重要治疗选择，但其长期效果，包括折叠瓣环的远期情况，却鲜为人知。我们回顾性分析了2005年至2020年间接受德维加瓣环成形术的小儿患者的治疗经验。通过经胸超声心动图对三尖瓣进行评估。根据患者情况，瓣环折叠的目标直径为正常三尖瓣直径的80%至90%。该研究纳入了55例患者（41例双心室生理状态患者（B组），14例单心室生理状态患者（U组）），中位随访时间为5.0年。手术时的中位年龄为5.0岁。有1例患者因严重二尖瓣反流晚期死亡。5例患者需要再次进行三尖瓣手术，整个队列的10年再次手术自由度为91.9%。B组中死亡、再次手术和严重TR复合不良结局的10年自由度为79.2%，U组为56.6%（p = 0.034）。术后TR分级显著降低（p < 0.001），术后随访期间无明显加重。无患者出现三尖瓣狭窄。术后即刻和最近一次随访时瓣环直径的平均Z值分别为-0.65±0.56和-0.47±0.65（p = 0.57）。对于包括单心室生理状态患者在内的小儿功能性TR患者，德维加瓣环成形术是一种安全、有效且持久的手术方法，可使折叠瓣环充分生长，且不会导致三尖瓣狭窄进展。
