van Son J A, Danielson G K, Schaff H V, Miller F A
Divisions of Thoracic and Cardiovascular Surgery and Cardiovascular Diseases, Mayo Clinic, Rochester, Minn. 55905.
J Thorac Cardiovasc Surg. 1994 Nov;108(5):893-8.
From 1964 through June 1993, thirteen patients with traumatic tricuspid insufficiency were treated surgically; all were male, and the ages ranged from 17 to 64 years (median 39 years). The condition was associated with blunt chest trauma in all patients: motor vehicle accidents in twelve and an explosion of a tank of compressed air in one. The median duration between trauma and operation was 17 years (range 1 month to 37 years). Preoperatively, six patients were in sinus rhythm and seven were in atrial fibrillation. At operation, the right ventricular function appeared moderately to severely depressed in twelve patients. In twelve patients, the anterior leaflet was flail because of chordal rupture (n = 9), rupture of anterior papillary muscle (n = 3), or tear in the anterior leaflet (n = 1). In one patient, the septal leaflet was missing and in another it was retracted and adherent to the ventricular septum. In five patients the tricuspid valve was repaired and in eight it was replaced. In seven patients in the latter group, the chordae, papillary muscles, and/or tricuspid valve leaflet(s) were found to be in a contracted and atrophic state, precluding repair. No early or late deaths occurred. At follow-up extending to 26 years (median 12 years), 12 patients are in New York Heart Association class I and one patient is in class II. Nine patients were in sinus rhythm and four were in atrial fibrillation. Although our experience indicates that good functional results can still be achieved many years after the onset of traumatic tricuspid valve insufficiency, earlier diagnosis and surgical treatment should increase the feasibility of tricuspid valve insufficiency, earlier diagnosis and surgical treatment should increase the feasibility of tricuspid valve repair, prevent progressive deterioration of right ventricular function, and increase the possibility of maintaining late sinus rhythm in a greater number of patients.
从1964年至1993年6月，13例创伤性三尖瓣关闭不全患者接受了外科治疗；均为男性，年龄在17至64岁之间（中位数39岁）。所有患者的病情均与钝性胸部创伤有关：12例为机动车事故，1例为压缩空气罐爆炸。创伤与手术之间的中位时间为17年（范围1个月至37年）。术前，6例患者为窦性心律，7例为心房颤动。手术时，12例患者的右心室功能表现为中度至重度减退。12例患者中，前叶因腱索断裂（9例）、前乳头肌破裂（3例）或前叶撕裂（1例）而呈连枷状。1例患者的隔叶缺失，另1例隔叶回缩并粘连于室间隔。5例患者的三尖瓣进行了修复，8例进行了置换。后一组中的7例患者，发现腱索、乳头肌和/或三尖瓣叶处于收缩和萎缩状态，无法修复。无早期或晚期死亡发生。随访时间长达26年（中位数12年），12例患者纽约心脏协会心功能分级为I级，1例为II级。9例患者为窦性心律，4例为心房颤动。虽然我们的经验表明，创伤性三尖瓣关闭不全发病多年后仍可取得良好的功能结果，但早期诊断和外科治疗应能提高三尖瓣修复的可行性，防止右心室功能进行性恶化，并增加更多患者维持晚期窦性心律的可能性。
