Sullivan M F, Roberts W C
Am J Cardiol. 1986 Oct 1;58(9):781-9. doi: 10.1016/0002-9149(86)90354-1.
Clinical and morphologic observations are described in 12 patients who underwent simultaneous replacement of the tricuspid, mitral and aortic valves. All 12 patients had mitral stenosis, 10 aortic valve stenosis and 2 pure aortic valve regurgitation; 5 had tricuspid valve stenosis and 7 pure tricuspid valve regurgitation. Of the 10 patients who died within 60 days of triple valve replacement, 7 had the low cardiac output syndrome, which in 4, and possibly 5, of the 7 was attributed to prosthetic aortic valve stenosis. In none of the 12 patients was the ascending aorta dilated, and in the 4 (possibly 5) patients with low cardiac output, the space between the surface of the caged poppet (4 patients) or margins of the tilting disc (1 patient) in the aortic valve position and the aortic endothelium appeared inadequate to allow unobstructed flow despite small-sized prostheses in all but 1 patient. Thus, aortic valve replacement in the setting of triple valve dysfunction is hazardous or potentially so. The relative small sizes of the hearts in these patients also make valve replacement more difficult (and hazardous) compared to hearts with larger ventricles and aortas.
本文描述了12例同时进行三尖瓣、二尖瓣和主动脉瓣置换术患者的临床及形态学观察结果。12例患者均有二尖瓣狭窄，10例有主动脉瓣狭窄，2例为单纯主动脉瓣反流；5例有三尖瓣狭窄，7例为单纯三尖瓣反流。在三尖瓣置换术后60天内死亡的10例患者中，7例出现低心排血量综合征，其中7例中的4例（可能5例）归因于人工主动脉瓣狭窄。12例患者中升主动脉均未扩张，在4例（可能5例）低心排血量患者中，除1例患者外，其余患者尽管使用了小号人工瓣膜，但主动脉瓣位置的笼球瓣（4例）表面或倾斜碟瓣（1例）边缘与主动脉内皮之间的间隙似乎不足以保证血流不受阻碍。因此，在三尖瓣功能障碍的情况下进行主动脉瓣置换术是危险的或有潜在危险。与心室和主动脉较大的心脏相比，这些患者心脏相对较小也使瓣膜置换更加困难（且危险）。
