Real-time measurement of tricuspid valve annular area for annuloplasty. Experimental study

We used real-time measurement of the tricuspid valve annular area in anesthetized dogs to study the optimal size of the annular area for annuloplasty. During control conditions, the maximum tricuspid annular area appeared at the onset of ventricular systole. The minimum tricuspid annular area appeared between the ventricular isovolumic relaxation phase and the early ventricular filling phase. The maximum annular area varied in seven dogs between 2.18 and 3.10 cm2, and the minimum annular area ranged between 1.68 and 2.45 cm2. In regular sinus rhythm (heart rates 97 to 120 beats/min), the maximal decreases in tricuspid annular area during one cardiac cycle ranged from 14.3% to 23.6% of the maximum size. When the tricuspid annular area after the annuloplasty was kept larger than the minimum area that was observed during the cardiac cycle in the control study, cardiac output and right atrial pressure remained unchanged, as a result of unobstructed ventricular filling. On the other hand, when the annular area was reduced to smaller than the minimum area seen in the control study, a decrease in cardiac output and an elevation of right atrial pressure ensued. These findings suggest that the tricuspid annular area can be safely decreased by annuloplasty to the minimum area seen in the control study without causing a reduction of cardiac output or an elevation of right atrial pressure.     

Direct imaging of the tricuspid valve annular motions by fiberoptic cardioscopy in dogs. I. Does De Vega's annuloplasty preserve the annular motions?

Applying the technology of direct imaging by fiberoptic cardioscopy, physiologic and pathophysiologic motions of the tricuspid valve anulus were studied in 10 anesthetized normal dogs (control group) and in 9 dogs that had chronic tricuspid regurgitation (TR group). The heart was perfused with transparent modified Tyrode's solution by working heart method, and the anuli, outlined by sutured beads, were observed and recorded on a high-speed video system in real time. Tricuspid valve annular area was calculated at 14 points during the cardiac cycle. The control group was studied in the normal condition, and the tricuspid regurgitation group was studied during four interventions: nontricuspid annuloplasty group and three tricuspid annuloplasty groups with reducing tricuspid valve annular area to 80%, 65%, and 50% of that of the non-tricuspid annuloplasty group by De Vega's procedure. Tricuspid valve annular area in the control group increased by 7% during atrial systole and was reduced by 34% mainly during ventricular systole, in which the free wall annular area and the septal annular area narrowed by an equal 34%. Chronic tricuspid regurgitation lessened tricuspid valve annular area narrowing to 20% in percent reduction (p < 0.01). In the TR group the decrease in tricuspid valve annular area narrowing was attributed mainly to lessened narrowing of the free wall anulus (percent reduction of tricuspid valve annular area, 19%; p < 0.01). The amplitudes in tricuspid valve annular area narrowing were unchanged in the tricuspid annuloplasty groups even when tricuspid valve annular area, was reduced to 50% by De Vega's tricuspid annuloplasty (percent reduction of tricuspid valve annular area, 16%; not significant). These findings suggest that De Vega's tricuspid annuloplasty is a reasonable method that does preserve the physiologic annular motions in the opening and closing mechanism of the tricuspid valve.     

Modification of De Vega's Tricuspid Annuloplasty for Experimental Tricuspid Regurgitation

We propose a new experimental model of tricuspid annular dilatation and provide some modifications to De Vega's tricuspid annuloplasty to treat this condition. Tricuspid annular dilatation was done by creating ten 1.5-mm incisions around the circumference of the tricuspid annulus. The annulus became significantly dilated from 7.6 cm to 9.4 cm (p < 0.01). After dilatation, 2–0 polypropylene stitches were placed circumferentially around the tricuspid annulus and the suture ends were brought outside the heart through the right atrial wall. After cardiac resuscitation, the following hemodynamic variables were measured as preload was increased incrementally: mean right atrial pressure, v wave of atrial pressure, right ventricular end-diastolic pressure, and cardiac output. Measurements were obtained and preload-output curves were constructed for three time periods: before annular dilatation (Control); after dilatation, but before external adjustment (Before); and after external modification of the annulus (After). Following cardiac resuscitation, right atrial and ventricular pressures were significantly higher after annular dilatation, compared to control values. The preload-output curve was shifted to the right, and cardiac output could not be increased above 0.9 L/min. Once the extracardiac adjustment was accomplished, these pressures were returned to control values, and the preload-output relationship was returned to normal curve. (J Card Surg     

Three-dimensional geometric comparison of partial and complete flexible mitral annuloplasty rings

BACKGROUND: It has previously been shown in sheep that mitral annular physiologic dynamics during the cardiac cycle are abolished by complete ring annuloplasty, but recent clinical studies suggest that flexible partial ring annuloplasty preserves normal mitral annular dynamics. METHODS: Eight radiopaque markers were sutured equidistantly around the mitral anulus in 3 groups of sheep: no-ring control animals (n = 16); animals with a flexible Tailor partial ring annuloplasty (n = 6; St Jude Medical, Inc, St Paul, Minn); and animals with a flexible Duran ring annuloplasty (n = 7; Medtronic, Inc, Minneapolis, Minn). After 7 to 10 days' recovery, 3-dimensional marker coordinates were measured by biplane cinefluoroscopy. Mitral annular area and folding (defined as displacement of the mitral anulus from a least-squares plane) and mitral annular septal-lateral and commissure-commissure dimensions were calculated from the 3-dimensional marker coordinates throughout the cardiac cycle every 17 ms. RESULTS: In the no-ring control group mitral annular area varied from 8.0 +/- 0.2 to 7.2 +/- 0.2 cm(2) (10% +/- 2%), and the septal-lateral and commissure-commissure dimensions varied from 27.7 +/- 0.4 to 25.9 +/- 0.4 mm (7% +/- 1%) and from 38.2 +/- 0.8 to 36.4 +/- 0.8 mm (5% +/- 1%), respectively (mean +/- standard error of the mean, P <.001 for all comparisons). In the Duran ring annuloplasty and Tailor partial ring annuloplasty groups, the anulus was fixed in size throughout the cardiac cycle (area = 4.8 +/- 0.1 and 5.3 +/- 0.3 cm(2), septal-lateral = 21.8 +/- 0.7 and 22.0 +/- 0.8 mm, and commissure-commissure = 27.7 +/- 0.7 and 31.2 +/- 1.7 mm). Mitral annular folding did not differ significantly between the control and Tailor partial ring annuloplasty groups but was dampened in the Duran ring annuloplasty group. CONCLUSIONS: Partial Tailor flexible ring annuloplasty fixed mitral annular area and dimensions throughout the cardiac cycle in sheep; however, it preserved physiologic mitral annular folding dynamics, which might be important in terms of long-term valve function and prevention of left ventricular outflow tract obstruction.     

应用彩色多普勒对二尖瓣置换术后三尖瓣功能的远期随访

目的应用彩色多普勒超声评价二尖瓣置换术后远期三尖瓣功能及形态变化。方法对接受二尖瓣置换术的903例病人术后三尖瓣功能进行了2～9年,平均(3.6±2.4)年的跟踪观察。所有病例术前均有不同程度的三尖瓣环扩大或关闭不全,其中未行三尖瓣成形术者201例;行Kay或改良DeVega成形术者686例;三尖瓣成形术同时加成形环者16例。结果未行三尖瓣成形术者术后2～3年有46例出现三尖瓣重度关闭不全;行Kay或改良DeVega成形术者,术后3～5年150例出现中重度三尖瓣关闭不全;三尖瓣成形术同时加成形环者仅1例术后2年出现三尖瓣轻-中度关闭不全。结论二尖瓣置换术后远期三尖瓣功能性关闭不全与三尖瓣环扩大、右心功能损害和严重肺动脉高压有关,三尖瓣环扩大是其重要的原因。对二尖瓣置换术者,手术中一旦发现有三尖瓣环扩大,即使无三尖瓣关闭不全,亦应行三尖瓣成形术,重度三尖瓣关闭不全、瓣环明显扩大者最好在环缩术的同时加成形环。     

Long-term evaluation of treatment for functional tricuspid regurgitation with regurgitant volume: characteristic differences based on primary cardiac lesion

OBJECTIVES: The aim of this study was to characterize differences in the long-term effects of treatment for functional tricuspid regurgitation based on the primary cardiac lesion. METHODS: Ninety-six patients with valvular heart disease and 32 patients with atrial septal defects associated with tricuspid regurgitation were studied. The tricuspid annular diameter was associated with evidence of right heart failure. In valvular heart disease, a Kay annuloplasty was performed in 33 patients with a tricuspid annular diameter of >/=40 mm to 44 mm, a modified De Vega annuloplasty in 12 patients with a tricuspid annular diameter of >/=45 mm to 49 mm, and a modified De Vega annuloplasty, annuloplasty using a Carpentier ring, or tricuspid valve replacement in each of 4 patients with a tricuspid annular diameter of >/=50 mm. In atrial septal defects, a Kay annuloplasty was performed in 11 patients with a tricuspid annular diameter of >/=45 mm to 49 mm, and a modified De Vega annuloplasty was performed in 5 patients with a tricuspid annular diameter of >/=50 mm. A mean follow-up period was 79 months after operation. RESULTS: In the patients with a tricuspid annular diameter of <50 mm, the hemodynamic and clinical findings and tricuspid regurgitation remarkably improved. In the patients with valvular heart disease with a tricuspid annular diameter of >/=50 mm, however, the right heart parameters also showed improvement but less so when compared with those patients with a tricuspid annular diameter of <50 mm. In addition, 4 patients undergoing a modified De Vega annuloplasty have had a gradual increase in tricuspid regurgitation and clinical manifestations late after the operation. In contrast, all 5 patients with atrial septal defects with a tricuspid annular diameter of >/=50 mm have shown remarkable improvement, similar to those with a tricuspid annular diameter of <50 mm. Preoperative analyses revealed that the right heart function in atrial septal defects had not deteriorated to the same extent as in valvular heart disease. CONCLUSION: In the patients with a severely dilated tricuspid anulus (>/=50 mm), the postoperative change of tricuspid regurgitation differed between those patients with valvular heart disease and atrial septal defects.     

Observation of the right atrial wall suture line after tricuspid valve supra-annular implantation

Strength of the right atrial wall suture line after tricuspid valve supra-annular implantation (TVSI) is controversial. We observed the right atrial supra-annular position of a 63-year-old male during his third mitral operation who underwent mitral valve replacement (MVR) and TVSI 15 years ago. Eight years later, he received the second MVR and removal of the bioprosthetic valve from the tricuspid position due to primary tissue failures. The annular size of the tricuspid valve had decreased enough to be fixed by tricuspid annuloplasty (TAP) and re-TVSI was not needed at that time. In this operation, 7 years following bioprosthetic valve removal, the circularly bulging atrial wall still remained and seemed to have enough strength for holding the prosthetic valve. This finding may support the conclusion that the right atrial wall has enouth strength for holding a prosthetic valve in position.     

New quantitative method for evaluating tricuspid regurgitation

A new quantitative method for evaluating regurgitation (TR) is proposed in order to select the most suitable treatment for functional TR associated with acquired valvular heart disease. The regurgitant volume per beat (VTR) is calculated using two-dimensional color Doppler and continuous-wave Doppler echocardiographies. In a study of 48 patients, preoperative VTR showed a significant correlation with tricuspid annular diameter at end-diastole, right atrial mean pressure and right ventricular end-diastolic pressure. Patients were classified into 3 groups according to preoperative VTR: Group I, VTR less than 10 cc (no. 18); Group II, VTR = 10-20 cc (no. 18); Group III, VTR greater than or equal to 20 cc (no. 12). This classification correlated well with the intraoperative findings of TR. In all Group I patients, VTR decreased without any tricuspid valve repair. In Group II, 17 of 18 patients underwent tricuspid annuloplasty, and showed a decrease in VTR to below 10 cc after surgery. In Group III, 10 underwent tricuspid annuloplasty and 2 tricuspid valve replacement. Three of the 10 with tricuspid annuloplasty showed a significant degree of postoperative VTR (10-20 cc). These 3 patients as well as the 2 with tricuspid valve replacement showed a preoperative peak-to-peak pressure difference across the tricuspid valve during the ejection phase (RVsp-TAv) of less than or equal to 20 mmHg and tricuspid annular diameter at end-diastole of greater than or equal to 50 mm. In conclusion, no tricuspid valve repair was required in Group I (TR I). For group II (TR II) patients, tricuspid annuloplasty was necessary and adequate for TR correction. For Group II (TR III) patients, a more substantial procedure like tricuspid valve replacement should be performed, especially when the preoperative RVsp-RAv is less than or equal to 20 mmHg and tricuspid annular diameter at end-diastole is greater than or equal to 50 mm.     

Sliding tricuspid valvuloplasty for severe tricuspid regurgitation after corrective surgery of a ventricular septal defect

We encountered a case of massive tricuspid regurgitation after corrective surgery for a ventricular septal defect. Fixation of the septal leaflet to the ventricular septum at the point where it was closed with a pericardial patch and marked annular dilatation were the lesions contributing to the severe tricuspid regurgitation. The posterior leaflet of the tricuspid valve was excised from the tricuspid annulus, slid to the adhering septal leaflet, and then reattached to a safe area of the septal leaflet to prevent conduction disturbance. The sliding repair was supported by annuloplasty with a Carpentier–Edwards ring, and a concomitant right-sided Maze procedure was conducted for atrial flutter.     

Echocardiographic findings using tissue velocity imaging following passive containment surgery with the Acorn CorCap cardiac support device.

OBJECTIVE: To echocardiographically evaluate the effects of passive containment surgery using the CorCap Cardiac Support Device in heart failure patients with dilated cardiomyopathy. METHODS: Twelve patients with dilated cardiomyopathy subjected to cardiac surgery received the Cardiac Support Device. Patients with ischemic cardiomyopathy (n=5) underwent coronary artery bypass surgery receiving 1-3 bypass grafts. In the idiopathic cardiomyopathy group (n=7), mitral valve annuloplasty was performed in five patients while two patients received the Cardiac Support Device only. RESULTS: Following surgery there was a gradual, sustained improvement in cardiac dimensions (decreased left ventricular end-diastolic diameter and left ventricular end-systolic diameter) combined with an increase in functional status (6-min walk and NYHA class). Concomitantly there was a marked decrease in right ventricular function (decrease in tricuspid annular systolic and diastolic velocities) while the left ventricular function (mitral annular systolic and diastolic velocities) and output (ejection fraction, stroke volume) remained unchanged. CONCLUSIONS: Addition of the Cardiac Support Device to conventional cardiac surgery improves patient status and decreases left ventricular size in heart failure patients with dilated cardiomyopathy. The positive effect on left ventricular dimensions is not accompanied by any improvement in cardiac output but rather right ventricular dysfunction, although the functional significance of this is unclear.     

Direct imaging of the tricuspid valve annular motions by fiberoptic cardioscopy in dogs with tricuspid regurgitation. II. Does flexible ring annuloplasty preserve the annular motions?

Applying the technology of direct imaging by fiberoptic cardioscopy in a working-heart condition, we studied the tricuspid valve annular motions with flexible rings in nine dogs with chronic tricuspid regurgitation. Three annuloplasty studies with a totally flexible polytetrafluoroethylene ring, an elastic silicone ring, and a rigid metal ring were compared with a nonannuloplasty study. The annuloplasty was performed by reducing tricuspid valve annular area to 65% of that of nonannuloplasty condition. The anuli were observed and recorded on a videotape in real time. The three rings effectively reduced and remodeled the dilated anuli and improved the valve coaptation. The patterns of annular motions with the polytetrafluoroethylene and silicone ring were similar to that of normal anulus; the free wall anulus contracted centripetally, and the septal anulus moved toward the free wall side during systole. Pliability of both the anteroseptal and posteroseptal commissures with the flexible rings made these motions possible. The polytetrafluoroethylene ring followed a natural undulation of the anulus, whereas the silicone and rigid metal rings forced the annular planes to horizontal ones. Percent reductions of tricuspid valve annular area were 25%, 21%, and 23% in the nonannuloplasty, polytetrafluoroethylene, and silicone ring studies, respectively, without significant differences in annular contraction. In contrast, rigid metal rings completely disturbed the annular motions. These findings indicated that the two flexible rings did preserve the physiologic annular motions to the degree that the anuli had in the chronic tricuspid regurgitation condition. Especially, the totally flexible polytetrafluoroethylene ring preserved not only the annular motions but also the natural undulation, which resulted in reinforcing the valve coaptation. We believe that the flexible ring, especially a totally flexible one, is superior to the rigid ring in the aspect of reinforcing the valve coaptation to prevent further regurgitation.     

Role of the septal leaflet in tricuspid valve closure. Consideration for treatment of complete atrioventricular canal.

A septal leaflet of the tricuspid valve is thought to work differently from other anterior and posterior leaflets. We studied its role in valve closure in dogs by means of a dynamic area meter. During the control state, the tricuspid valve orifice area increased twice in diastole coincidentally with either atrial systole or rapid ventricular filling. We observed several findings after the septal leaflet resection: (1) two peak area patterns of the tricuspid valve orifice in diastole, (2) no elevation of right atrial pressure on ventricular systole (there was no V wave), (3) no tricuspid valve regurgitation on right ventriculography. These findings suggest that a complete valve closure occurred without the septal leaflet in regular sinus rhythm. An elevation of the right ventricular pressure produced by pulmonary artery stenosis without septal leaflet, however, easily caused tricuspid valve regurgitation in contrast to the same pressure of the right ventricle with the normal tricuspid valve. The right ventricular pacing caused severe valve regurgitation without the septal leaflet. Results indicate that in the repair of the complete atrioventricular canal defect and other tricuspid valve lesions, the septal leaflet of the tricuspid valve rarely requires attention. An atrioventricular block should be avoided, however, because electrical cardiac pacing on the right ventricle causes severe valve regurgitation without the septal leaflet.     

Modified tricuspid ring annuloplasty to reduce residual regurgitation in functional tricuspid regurgitation

We describe a modified technique of tricuspid ring annuloplasty to reduce postoperative residual regurgitation in patients with functional tricuspid regurgitation; first, an adjustable segmental tricuspid annuloplasty is performed to obtain coaptation of the valve leaflets with two 5-0 monofilament annular sutures, and then a prosthetic ring of the same size as the competent valve area is implanted with continuous 3-0 polypropylene sutures.     

Surgical treatment of tricuspid insufficiency in patients undergoing mitral valve replacement

During the past eight years, 46 of the 106 patients who underwent mitral valve replacement were associated with tricuspid insufficiency. No surgical correction was performed (14 cases) in cases of slight tricuspid insufficiency. Tricuspid annuloplasty (11 cases) or valve replacement (21 cases) was employed according to the severity of insufficiency. In the non-repair group, the mortality rate was fairly low (21 per cent), but the postoperative status was the least satisfactory by the NYHA classification. Tricuspid insufficiency was significantly reduced only in two of these 14 cases after the mitral valve replacement. In the tricuspid annuloplasty group, although the technique of tricuspid annuloplasty did not always correct insufficiency completely, only one patient died of residual insufficiency. The cardiac output measured with Minnesota Impedance Cardiograph increased postoperatively in proportion to stress in this group. In the tricuspid valve replacement group, cardiac catheterization studies revealed hemodynamic improvement at rest in all, but cardiac output during exercise remained unchanged or decreased in some cases. Now we consider that tricuspid insufficiency with advanced mitral valve disease, even of a slight degree, should be surgically treated and that annuloplasty has more obvious hemodynamic benefits than valve replacement.     

Experimental evaluation for tricuspid annular constriction with the model of tricuspid annular dilatation

We have obtained the good result about tricuspid annular constriction (TAC) for secondary tricuspid insufficiency. The purpose of this study is to investigate the effectiveness of TAC for the experimental model of tricuspid annular dilatation. First of all, tricuspid annular dilatation was made surgically in 8 mongrel dogs by placing 8 incisions to tricuspid annulus except septal cusp under the condition of heart-lung preparation. On clinical evaluation, septal annulus was kept to be intact in many cases compared with the two other areas. This experimental model of tricuspid annular dilatation was considered to be substituted to the clinical model of tricuspid annular dilatation. TAC suture was surrounded circumferentially around the dilated tricuspid annulus. And then, TAC suture was pulled out from the right atrial wall, and the circumferential length of tricuspid annulus was completely accommodated by pulling the TAC suture. The hemodynamic status was observed by right atrial pressure (V wave and mean) and right ventricular end-diastolic pressure (RVEDP). After heart resuscitation and gradual increase of preload, right atrial pressure was significantly elevated especially right atrial pressure (V wave) compared with control values. When 2 cm of circumferential length of tricuspid annulus on an average was constricted by shortening of TAC suture, right atrial pressure was significantly decreased, and then RVEDP tended to decrease. It was shown that TAC was an effective operative technique for the secondary tricuspid annular dilatation and tricuspid insufficiency from the standpoint of experimental aspect as well as clinical results.     

Tricuspid annuloplasty--modified technique

A modification of the DeVega's tricuspid annuloplasty (TAP) in the treatment of tricuspid regurgitation (TR) is described. Using a double-ended 2-0 Ethibond suture buttered with a Teflon felt pledget, a double suture line is begun at the center of the annulus of the anterior tricuspid valve leaflet. The two suture lines 2 to 3 mm apart are run around the edge of the annular ring of the anterior and posterior tricuspid valve leaflets, going over the posteroseptal commissure by 1.5 cm. A tiny piece of Teflon felt is placed at the end of the sutures. The annulus is narrowed to sungly allow passage of a prove with a diameter of 28 or 30 mm. The tricuspid function is assessed by injecting saline into the right ventricle through the right atrium. Between March 1986 and July 1989, 28 patients with functional TR secondary to mitral valve diseases have been operated on by this technique. There are one early and one late deaths, none being related to tricuspid valve annuloplasty. All 26 survivors had a significant drop in right atrial pressure and an associated improvement in clinical status. Follow-up of the 27 patients who survived this TAP ranges from 2 to 38 months (mean 17 months). This annuloplasty is a safe, effective and readily teachable method for the surgical management of TR.     

Isolated severe tricuspid regurgitation in a post pneumonectomy patient with chronic atrial fibrillation

Severe primary tricuspid regurgitation is a rare entity, with most cases of tricuspid regurgitation being functional and secondary to pulmonary hypertension from left heart pathologies. We report an unusual case of a female patient with a history of left pneumonectomy and chronic atrial fibrillation many years earlier, and who subsequently developed tricuspid annular dilatation, resulting in severe isolated primary tricuspid regurgitation despite normal pulmonary artery pressures and left ventricular systolic function. She required multiple hospitalizations for right heart failure and continued to be NYHA class IV despite receiving maximal medical management. She finally underwent an isolated tricuspid valve ring annuloplasty, which gave her symptomatic relief. Postoperatively, she improved to NYHA class 1-II still with chronic atrial fibrillation and mild to moderate tricuspid regurgitation at the time of her death 9 years later from pneumonia.     

Modified semicircular constricting annuloplasty (Sagban's annuloplasty) in severe functional tricuspid regurgitation: alternative surgical technique and its mid-term results

OBJECTIVE: De Vega annuloplasty is one of the most effective methods used in surgical correction of functional tricuspid regurgitation (FTR). Physiologic annular motions are protected by De Vega annuloplasty. However, recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon may be seen after De Vega annuloplasty as a result of gliding (jiggle) effect. The aim of this new annuloplasty was to prevent Bowstring phenomenon seen in De Vega annuloplasty. METHODS: Twenty-five patients with severe FTR secondary to the left-sided valvular heart disease were included in this study. Modified semicircular constricting annuloplasty (Sagban's annuloplasty): The procedure is performed utilizing 0 and 2-0 polypropylene sutures. At first, 0 and 2-0 polypropylene sutures are fixed and knotted at anteroseptal and posteroseptal comissural regions (named as anchoring points). 2-0 Polypropylene sutures which come from anchoring points in clockwise and counterclockwise direction are used to encircle the free wall annulus as well as 0 polypropylene sutures in spiral fashion (spiral annulary suture technique). When both sutures get to the anteroposterior comissural region (tying point), they are passed through plastic snares. After the annuloplasty is completed, with the heart beating and the pulmonary artery clamped, competency of the valve is tested by injecting saline into the right ventricular chamber before the adjusting suture is tied. In this annuloplasty, 0 polypropylene sutures are used for reduction and constriction, 2-0 polypropylene sutures are used for the fixation of 0 polypropylene sutures in annular level. RESULTS: FTR improved totally in 16 patients (66.7%), 4 patients (16.7%) had first degree, 3 patients (12.5%) had second degree, and only 1 patient (4.2%) had third degree residual tricuspid regurgitation in an average follow-up period of 17.8 months. One patient died from low cardiac output in early postoperative period. CONCLUSION: There is no risk of recurrent regurgitation secondary to Bowstring phenomenon in this alternative annuloplasty technique and this annuloplasty is cost-effective and performed easily.     

先天性三尖瓣发育不全的外科治疗

报告１１例先天性三肖瓣发庆膛全外科治疗病例。方法：中度低温体外循环下经右房行三泊瓣成形术８例中ＤｅＶｅｇａ６例，Ｋａｙ２例，三尖瓣替换术３例中高位替换２例，原位替换１例。结果：１１例病均痊愈出院。     

Surgical management of tricuspid regurgitation in patients undergoing mitral valve surgery--analysis of the amount of tricuspid valve annular dilatation]

As a means to determine whether correction for tricuspid regurgitation (TR) in mitral valve surgery is necessary, pulsed Doppler echocardiography was used to study 61 patients (age 49.5 +/- 9.5 years) who underwent mitral valve surgery. Early postoperative tricuspid regurgitation (average 9 +/- 3 postoperative days) was evaluated by a comparison with tricuspid valve annular dilatation and systolic annular shortening in preoperative right ventriculography. Kishimoto's method was used to measure the angiographic maximal early systolic (TVD) and minimal end-systolic diameters where as the shortening of the tricuspid annulus (STA) was expressed as a percent reduction in the maximal diameter by Ubago's methods. Patients were categorized into two groups, i.e., a group having had tricuspid annuloplasty (TAP group n = 23), and a NON-TAP group (n = 38). Preoperative right ventricular volume and hemodynamic indicator were studied with respect to both the TVD and the STA. Results are as follows: 1) The TVD significantly correlated with the end-diastolic right ventricular volume index (EDVI), regurgitant fraction of the tricuspid valve (RF), end-systolic right ventricular volume index (ESVI), pulmonary vascular resistance (PVR), mean pulmonary artery pressure (PAm), mean right atrial pressure (RAm), and right ventricular end-diastolic pressure (RVEDP) (p less than 0.01). 2) The STA was significantly correlated with EDVI, RF, ESVI, RAm and RVEDP (p less than 0.01). In the NON-TAP group, the TVD was significantly larger in patients with residual TR (average 32.5 mm/m2) than in patients having postoperative disappearance of TR (average 25.7 mm/m2) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)