风湿性二尖瓣病变继发三尖瓣关闭不全的外科治疗

目的探讨重度二尖瓣病变合并功能性三尖瓣关闭不全合理手术指征、方法及围手术期处理。方法回顾分析三尖瓣成形矫正功能性三尖瓣关闭不全84例,男性52例,女性32例,年龄12～69岁,其中采用Devega成形30例,节段性Devega成形34例,Key’s成形和改良Key’s成形各10例。同时施行二尖瓣置换52例,二尖瓣+主动脉瓣置换32例。结果术后早期死亡4例,死亡率48%;迟发性心包压塞6例均经心包引流治愈。随访3个月～15年,获访66例,2例死于顽固性心力衰竭,其余心功能均明显改善。超声心动图示右心房右心室较术前明显缩小。26例三尖瓣仍有轻、中度反流。结论根据三尖瓣环扩大部位和反流程度,选择不同成形方式对功能性三尖瓣关闭不全治疗满意。围手术期及术后加强强心、利尿、扩血管治疗及有效降低肺动脉高压,可进一步提高三尖瓣成形近、远期疗效。

Surgical treatment of fuctional tricuspid insufficiency succeeding to rheumatic mitral valve disease

Objective:To discuss the operative indication,procedures and peri|operative care of functional tricuspid insufficiency(FTI) succeeding to rheumatic valve disease.Method:Tricuspid valve anuloplasty was performed in 84 cases with FTI.52 were males and 32 females,aged 12～69 years old.De vega procedure was performed in 30 cases,segmental De vega in 34 cases.Kay procedure and improved Kay procedure in 10 cases respectively.Associated prcedures included mitral valve replacement in 52 cases and combined aortic and mitral valve replacement in 32 cases. Result:The early death was 4 cases(4.8%).Delay cardiac tamponade occurred in 6 cases and treated by pericardiostomy.Follow|up was 3 months to 15 years,two cases died of cardiac failure,and the others were considerably improved in cardiac function.The diameter of right atrium and ventriculus were shorten than pre|operation and mild to moderate tricuspid insufficiency in 26 cases.Conclusion:According to the dilatation position of tricuspid annulus and the degree of FTI,we chose different methods of anuloplasty and got satisfactory results.Cardiac diuretic and vasodilator drug can reduce pulmonary hypertension and improve late results.