两种三尖瓣环成形术的近期临床效果评价

目的评价功能性三尖瓣中、重度关闭不全患者行人工环成形术和De Vega成形术后的近期临床效果。方法2010年1月-2012年12月，我院行三尖瓣环成形术65例。根据手术方式分为2组：De Vega成形组（De Vega组）30例，人工环成形组（人工环组）35例。对所有患者在不同随访时间点采用超声心动图观察术后三尖瓣的反流情况，比较两组患者近期手术疗效。结果术后两组患者均无手术死亡；随访0.5-2.6年。术后心功能分级均较术前改善2-3级；术后6个月，右心房内径、右心室内径和肺动脉收缩压均比术前降低（P〈0.05），成形环组术后2年肺动脉收缩压仍有下降趋势（P〈0.05）。成形环组术后6个月三尖瓣反流轻度以下者为100%，术后1年、2年未见三尖瓣反流加重病例；De Vega组术后6个月、1年、2年三尖瓣反流轻度以下者分别为83.3%、94.5%和88.9%，三尖瓣中度反流者分别为16.7%、4.5%和11.1%，无重度反流病例。结论应用三尖瓣成形环行三尖瓣环成形术，其近期效果优于De Vega成形术，但其远期效果还需进一步随访观察。

Evaluation of clinic effects after different tricuspid valvuloplasty in patients with secondary tricuspid valve insufficiency

Objectives Tricuspid valve（TV） insufficiency secondary to valvular heart disease or congenital heart disease is the most common aetiology of tricuspid regurgitation（TR）. Appropriate treatment can improve long-term outcome. However, valve annuloplasty is the primary treatment for TV insufficiency. Our objective was to assess the short-term effectiveness of patients underwent tricuspid valve procedures for moderate or severe tricuspid regurgitation. These included De Vega suture tricuspid valve annuloplasty and ring annuloplasty. Methods A retrospective analysis of 65 consecutive patients with moderate to severe TR who underwent TV surgery between January 2010 and December 2012 with either a ring annuloplasty（Group Ring： n=35） or a De Vega suture annuloplasty （Group De Vega： n=30） at our hospital. The etiology for tricuspid regurgitation was rheumatic mitral and/or aortic valve diseases in 52 cases, adult atrial septal defect（ASD） in 13 cases. At different follow-up time point, the tricuspid regurgitation of all the patients was tested using ultrasound cardiography. The follow-up results were compared in 2 groups of patients. Results All patients survived from the operation. The follow up time was 0.5 to 2.6 years. The heart function improved to be NYHA class Ⅱ to Ⅲ in all patients. By 6 months after operation, right atrial diameter, right ventricle diameter and pulmonary artery systolic pressure in 2 groups was lower than the preoperative（P〈0.05）. However, by 2 years, pulmonary artery systolic pressure in ring group was still a downward trend（P〈0.05）. Echocardiography showed that trivial to mild TR was in all patients with ring annuloplasty after 6 months, and no moderate to severe TR war observed in one or two years later. By 0.5year, 1year and 2years follow up, echocardiography showed that trivial to mild TR was 83.3%, 94.5% and 88.9% respectively, and moderate TR was 16.7%, 4.5% and 11.1% respectively, but no severe TR cases in De Vega group. Conclusions In our experience, both De Vega annuloplasty suture and annuloplasty ring give satisfactory results, placement of an annuloplasty ring in patients undergoing tricuspid valve annuloplasty is significantly better than a De Vega＇s annuloplasty suture.The long-term effect still need further follow up.