De Simone R, Lange R, Sack R U, Mehmanesh H, Hagl S
Department of Cardiac Surgery, University of Heidelberg, Germany.
Ann Thorac Surg. 1995 Dec;60(6):1686-93. doi: 10.1016/0003-4975(95)00716-4.
The etiology of tricuspid and mitral valve regurgitation (TR and MR) after heart transplantation is still controversial.
We studied 25 patients undergoing transplantation and intraoperative transesophageal echocardiography to evaluate the incidence, the degree, and the cause of TR and MR. The degree of valve regurgitation was assessed by color Doppler echocardiography. Cross-sectional areas of the recipient (R) and donor (D) portions of the atria and their ratio (R/D) were measured to assess the distortion of atrial geometry. Tricuspid and mitral valve annuli, their systolic shortening, and hemodynamic indices were measured preoperatively and perioperatively.
Tricuspid valve regurgitation was found in 21 of 25 patients (84%) and MR in 12 of 25 (48%). The degree of MR was mild, whereas TR was mild to moderate. Mitral valve regurgitation did not show any correlation with the studied indices; TR showed no correlation with the hemodynamic indices but a significant correlation with R/D ratio (r = 0.90; standard error of the estimate = 0.2). An inverse correlation was found between the degree of TR and systolic shortening of tricuspid annulus (r = -0.88; standard error of the estimate = 0.03) and between R/D ratio and systolic shortening of tricuspid annulus (r = -0.85; standard error of the estimate = 0.04).
Tricuspid valve regurgitation has a higher incidence than MR and occurs immediately after transplantation; MR is mild and correlates with neither hemodynamic indices nor atrial distortion. An increased R/D ratio, and hence distortion of right atrial geometry, may lead to a reduction in systolic annulus shortening, which in turn causes TR. Surgical attempts to reduce the R/D ratio may decrease the incidence and the degree of TR after heart transplantation.
心脏移植后三尖瓣和二尖瓣反流（TR和MR）的病因仍存在争议。
我们研究了25例接受移植手术并术中行经食管超声心动图检查的患者，以评估TR和MR的发生率、程度及病因。通过彩色多普勒超声心动图评估瓣膜反流程度。测量心房受体（R）和供体（D）部分的横截面积及其比值（R/D），以评估心房几何形状的扭曲情况。术前和围手术期测量三尖瓣和二尖瓣环、其收缩期缩短情况及血流动力学指标。
25例患者中有21例（84%）发现三尖瓣反流，25例中有12例（48%）发现二尖瓣反流。二尖瓣反流程度较轻，而三尖瓣反流为轻至中度。二尖瓣反流与所研究指标无相关性；三尖瓣反流与血流动力学指标无相关性，但与R/D比值显著相关（r = 0.90；估计标准误 = 0.2）。发现三尖瓣反流程度与三尖瓣环收缩期缩短呈负相关（r = -0.88；估计标准误 = 0.03），R/D比值与三尖瓣环收缩期缩短也呈负相关（r = -0.85；估计标准误 = 0.04）。
三尖瓣反流的发生率高于二尖瓣反流，且在移植后立即发生；二尖瓣反流较轻，与血流动力学指标及心房扭曲均无相关性。R/D比值增加，进而导致右心房几何形状扭曲，可能导致收缩期瓣环缩短减少，从而引起三尖瓣反流。手术尝试降低R/D比值可能会降低心脏移植后三尖瓣反流的发生率和程度。
