Jang Dong Hee, Yoo Jae Suk
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Chest Surg. 2023 Jan 5;56(1):56-58. doi: 10.5090/jcs.22.077. Epub 2022 Oct 19.
Untreated severe tricuspid regurgitation (TR) is associated with poor outcomes. Functional TR occurs secondary to dilatation of the annulus and tethering of the leaflets. Ring annuloplasty alone can correct most cases, but is insufficient in cases of severe annular dilatation due to severe leaflet tethering. In such cases, a tricuspid edge-to-edge technique may be an option. However, stitching of the leaflet tips alone is likely to result in tearing of the leaflets. Approximation of the durable chordae tendineae is considered helpful for this problem. Herein, we present the case of a 39-year-old man who had undergone openheart surgery for acute type A aortic dissection 13 months earlier. A right mini-thoracotomy approach with a beating-heart strategy was used, which did not require unnecessary pericardial adhesiolysis and dissection. This technique had the advantage of reducing the operation time and the risk of bleeding. To summarize, we present a case of tricuspid valve repair in a high-risk patient with severe leaflet tethering that was successfully managed using these methods.
未经治疗的严重三尖瓣反流（TR）与不良预后相关。功能性TR继发于瓣环扩张和瓣叶的牵拉。单独的瓣环成形术可纠正大多数病例，但在因严重瓣叶牵拉导致严重瓣环扩张的情况下是不够的。在这种情况下，三尖瓣缘对缘技术可能是一种选择。然而，仅缝合瓣叶尖端可能会导致瓣叶撕裂。近似耐用的腱索被认为有助于解决这个问题。在此，我们介绍一例39岁男性患者，他在13个月前因急性A型主动脉夹层接受了心脏直视手术。采用了右胸小切口入路和心脏跳动策略，无需不必要的心包粘连松解和解剖。该技术具有减少手术时间和出血风险的优点。总之，我们介绍了一例严重瓣叶牵拉的高危患者的三尖瓣修复病例，使用这些方法成功进行了治疗。
