继发性三尖瓣关闭不全的外科治疗进展

继发于左心系统瓣膜病变的三尖瓣关闭不全,多为三尖瓣瓣环扩大导致的功能性三尖瓣关闭不全,也有少数患者同时合并三尖瓣风湿性等器质性改变。对三尖瓣反流的处理,目前主张如果能通过瓣膜成形方法恢复三尖瓣瓣膜功能,应尽量行三尖瓣成形手术。三尖瓣成形方法主要包括线性成形和人工瓣环成形技术,但目前各种手术成形方法的适应证选择和临床应用尚无统一的标准,多年来一直是困扰心脏外科医师的难题和研究热点,是否需要同期行三尖瓣成形术,采用什么成形方法才能达到最佳的三尖瓣成形效果。因此,对继发性三尖瓣关闭不全患者三尖瓣病变程度的判定、矫治标准及手术方法等进行综述。

Progress in Surgical Treatment of Secondary Tricuspid Insufficiency

Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation.Some patients had rheumatic tricuspid valve diseases.Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation.Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods.However,the indications for treatment of secondary tricuspid regurgitation remain controversial.The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging.In this article,we review the assessment of tricuspid valve lesions,criteria for correction,and surgical management of secondary tricuspid insufficiency.