以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察

目的初步观察采用三尖瓣瓣环径作为三尖瓣成形术指征是否有助于减少二尖瓣置换术（MVR）患者术后中重度三尖瓣反流（TR）的发生。方法选择2005年4月至2006年6月期间我科56例术前无或轻度TR的MVR患者纳入研究。以三尖瓣瓣环径/体表面积≥21mm/m2将患者分为三尖瓣成形组（TA组）和非三尖瓣成形组（NTA组）。TA组：22例,男8例,女14例;年龄45.0±7.7岁;三尖瓣瓣环径36.8±3.8mm,体表面积1.57±0.15m2;心功能分级（NYHA）级18例,～级4例;窦性心律2例,心房颤动20例。NTA组：34例,男9例,女25例;年龄42.9±11.0岁;三尖瓣瓣环径28.5±4.4mm,体表面积1.58±0.13m2;心功能分级级28例,～6例;窦性心律9例,心房颤动25例。TA组患者采用Kay法施行三尖瓣成形术。术后随访及术后6个月完成超声心动图检查。结果56例患者术后均康复出院。术后随访11.0±2.4个月,除2例外54例患者完成术后6个月超声心动图复查。两组患者一般临床特征比较差异无统计学意义（P〉0.05）。与NTA组比较,术前TA组患者右房径（49.3±7.0mm）、三尖瓣瓣环径较大（36.8±3.8mm）,有三尖瓣反流的患者较多（P〈0.05）,术后TA组患者右房径（44.1±8.9mm）、三尖瓣瓣环径（28.9±6.1mm）明显缩小,三尖瓣反流程度明显改善（P〈0.05）。NTA组患者术前、术后右房径、三尖瓣瓣环径和三尖瓣反流程度变化不明显（P〉0.05）,有3例患者出现TR。结论对术前无或轻度TR的MVR患者,采用三尖瓣瓣环径作为三尖瓣成形手术指征可能有助于减少这些患者术后中-重度TR的发生。

Preliminary Clinical Observation of Tricuspid Annuloplasty Adopting Tricuspid Annulus Diameter as Surgical Indication

Objective To observe whether the adoptation of tricuspid annulus diameter as surgical indication for tricuspid annuloplasty will reduce the occurrence of moderate-severe tricuspid regurgitation（TR） in patients after mitral valve replacement （MVR）. Methods Between April 2005 and June 2006, MVR was performed in 56 patients with no or mild TR in our Department. The patients were divided into two groups according to tricuspid annulus diameter （TAD）/body surface area （BSA）≥21mm/m^2. Tricuspid annuloplasty group （TA group） ： 22 cases, male 8, female 14, age 45.0±7. 7 years, TAD 36. 8±3.8mm, BSA 1. 57±0. 15m^2, New York Heart Association （NYHA） functional class Ⅲ / Ⅲ -Ⅳ 18/4, sinus rhythm（SR）/atrial fibrillation （AF） 2/20. No-tricuspid annuloplasty group （NTA group）： 34 cases, male 9, female 25, age 42.9±11.0 years, TAD 28.5±4.4mm, BSA 1.58±0.13m^2, NYHA Ⅲ/Ⅲ-Ⅳ 28/6, SR/AF 9/25. Kay annuloplasty was performed for TA group patients. The patients were followed in outpatient clinical regularly and evaluated by echocardiography at 6 months after operation. Results All patients recovered and were discharged from hospital. The duration of follow-up was 11.0±2.4 months. Except 2 cases, all patients received echocardiography evaluation at 6 months after operation. There were no significantly differences between two groups patients in general clinical characteristics （P〉0. 05）. Compared with NTA group before operation, right atrial diameter （RAD, 49.3±7.0mm） and TAD（36.8±3.8mm） were bigger and more mild TR in TA group （P〈0.05）. RAD（44. 1±8.9mm） and TAD（28.9±6.1mm） reduced and the proportion of TR degree improved （P〈0.05） in TA group but did not occur in NTA group after surgery （P〉0.05）. There were three cases of moderate TR in NTA group. Conclusion Tricuspid annuloplasty adopting TAD as surgical indication may reduce the occurrences of postoperative moderate-severe TR for patients of MVR with no or mild preoperative TR.