Sagie A, Schwammenthal E, Padial L R, Vazquez de Prada J A, Weyman A E, Levine R A
Department of Medicine, Massachusetts General Hospital, Boston 02114.
J Am Coll Cardiol. 1994 Aug;24(2):446-53. doi: 10.1016/0735-1097(94)90302-6.
The aim of this study was to investigate the association between the pattern of incomplete tricuspid valve closure and the presence of tricuspid regurgitation and to identify factors that determine the severity of regurgitation associated with this pattern.
The incomplete tricuspid valve closure pattern (defined as apical displacement of the leaflets) has been described by two-dimensional echocardiography. However, whether this pattern is universally associated with tricuspid regurgitation and the determinants of severity of regurgitation in its presence have not been studied by Doppler color flow mapping.
We identified 109 consecutive patients (mean age 62 +/- 17 years) with incomplete tricuspid valve closure who were studied by Doppler color flow mapping. We measured the linear apical displacement of the coaptation point from the tricuspid annulus and the area of displacement between the leaflets and annulus. Right atrial, ventricular and annular dimensions were measured and compared with those in a group of normal subjects.
Tricuspid regurgitation was present in all patients with the incomplete closure pattern; it was mild in 14%, moderate in 19% and severe in 67%. Apical displacement was significantly greater (p < 0.02) in those with severe regurgitation than in those with mild regurgitation or in normal subjects. Tricuspid annulus dilation was the only independent predictor of severity of regurgitation. The right ventricle was not significantly dilated in 32% of patients, and right ventricular systolic pressure was not correlated with the severity of regurgitation and was < 30 mm Hg in 11% of patients.
Tricuspid regurgitation was associated with incomplete tricuspid valve closure in all patients studied and was moderate to severe in 86%. Impaired coaptation is best reflected by the displacement area between the leaflets and the annulus. High pulmonary pressure and significant right ventricular dilation are not prerequisites for functional tricuspid regurgitation. Annular dilation is the most consistent and important determinant of this lesion.
本研究旨在探讨三尖瓣关闭不全模式与三尖瓣反流之间的关联，并确定决定与该模式相关反流严重程度的因素。
二维超声心动图已描述了三尖瓣关闭不全模式（定义为瓣叶的心尖移位）。然而，这种模式是否普遍与三尖瓣反流相关，以及在存在这种模式时反流严重程度的决定因素尚未通过多普勒彩色血流图进行研究。
我们通过多普勒彩色血流图研究了109例连续的三尖瓣关闭不全患者（平均年龄62±17岁）。我们测量了瓣叶贴合点距三尖瓣环的心尖线性移位以及瓣叶与瓣环之间的移位面积。测量右心房、心室和瓣环尺寸，并与一组正常受试者进行比较。
所有具有关闭不全模式的患者均存在三尖瓣反流；轻度反流占14%，中度反流占19%，重度反流占67%。重度反流患者的心尖移位明显大于轻度反流患者或正常受试者（p<0.02）。三尖瓣环扩张是反流严重程度的唯一独立预测因素。32%的患者右心室无明显扩张，11%的患者右心室收缩压与反流严重程度无关且<30mmHg。
在所有研究患者中，三尖瓣反流与三尖瓣关闭不全相关，86%为中度至重度。瓣叶与瓣环之间的移位面积最能反映瓣叶贴合受损情况。高肺压和明显的右心室扩张不是功能性三尖瓣反流的先决条件。瓣环扩张是该病变最一致且重要的决定因素。
