130例二尖瓣置换术同期行三尖瓣成形术的方法及意义

目的 探讨二尖瓣置换术(MVR)同期行三尖瓣成形术(TVP)的手术方法和意义。方法 191例二尖瓣病变同时伴有功能性三尖瓣关闭不全(T1)的患者,其中130例于MVR手术同期行TVP。70例轻度TI中,有7例行Kay氏法二瓣化成形术,2例行DeVega瓣环成形术;中度和重度TI均同期行TVP：其中中度TI 92例,行DeVega瓣环成形术57例,Kay氏法二瓣化成形术33例,人工瓣环固定术2例;重度TI 29例,行DeVega瓣环成形术6例,人工瓣环固定术23例。结果 130例中死亡3例,127例康复出院。122例随访29～112月,发现32例有轻度或极轻度三尖瓣返流(TR),7例中度TR,3例重度TR。结论二尖瓣病变同时伴有功能性TI的患者,在施行MVR同时,应行TVP,尤其是中重度TI更要积极处理。选择适当的手术方式,能有效纠正TI,阻止轻度TR加重,减少严重TR的发生率。

Methods and significance of mitral valve replacement concomitant with tricuspid valve plasty in 130 patients

Objective To evaluate the clinical methods and values of the mitral valve replacement (MVR) and tricuspid valve plasty (TVP). Methods Four hundred seventy patients undewent MVR. Among them,191 pa-tients had functional tricuspid insufficiency (TI) , among them, 70 patients with mild TI, 92 with moderate TI and 29 with severe TI. Seven patients underwent Kay' s bicuspid valvuloplasty and 2 with mild TI De Vega annuloplasty. In moderate TI patients 57 underwent De Vega annuloplasty, 33 Kay ' s bicuspid valvuloplasty, and artificial tricuspid rings were used in 2 patients. In severe TI patients 6 had De Vega annuloplasty, and 23 artificial rings. Results Three patients died and 127 patients recovered postoperatively. One hundred and twenty two survivors were followed up from 29 to 112 months. Among them, 32 had mild or trivial 7 moderate tricuspid regurgitation (TR) and 3 severe TR. Conclusion Proper surgical technique of TVP could effectively correct TI, prevent the development of mild TR and decrease postoperative occurrance of severe TR. Moderate and severe TI should be treated positively.