经导管三尖瓣置换装置LuX-Valve治疗重度三尖瓣反流的超声心动图评价

目的：评估新型经导管三尖瓣置换装置LuX-Valve治疗重度三尖瓣反流的临床和超声心动图表现。方法：入选2020年6月至2021年8月中国医学科学院阜外医院收治的NYHA心功能III～IV级外科高危重度三尖瓣反流患者。患者均经药物治疗无明显改善,使用LuX-Valve装置行经导管三尖瓣置换术。收集并分析患者手术前后及随访期临床及超声心动图资料。结果：共纳入36例患者,均成功行经导管三尖瓣置换术,无术中或术后72 h内死亡;除4例因器械位置异常行体外循环手术外,余32例（88.9%）手术成功。无住院死亡,2例病重出院。随访350(196,386)d期间,3例（8.3%）死亡。至末次随访时,66.7%(22/33)的患者NYHA心功能分级改善,72.7%(24/33)三尖瓣反流量少量及以下,右心房、室容积均较术前明显减小[分别为（115.58±67.74）ml vs.(161.08±95.50)ml,(118.76±50.45)ml vs.(136.65±55.44)ml,P均<0.05],但右心室射血分数变化无统计学意义。Cox回归分析显示,二尖瓣平均跨瓣压差是术后不良事件的独立危...     

3D超声心动图在导线介导三尖瓣反流中的应用价值

长期以来,导线介导的三尖瓣反流(lead-induced tricuspid regurgitation,LITR)作为起搏器医源性并发症并未得到充分认识与重视。常规超声在LITR成像诊断存在缺陷。近年来随着三维超声心动图(Three-dimensional echocardiography,3DE)的使用,在心脏介入手术管理中发挥着越来越重要的作用,可用于LITR的病理机制研究及反流严重程度的评估。     

心房颤动导管射频消融术逆转功能性三尖瓣反流的超声研究

目的 研究导管射频消融术对非瓣膜病性房颤患者中重度功能性三尖瓣反流的影响及逆转右心重构的作用.方法 采用前瞻性的研究方法,连续入选2010年12月至2012年6月632例非瓣膜病性房颤首次行导管射频消融手术的患者,于手术前（72 h内）进行二维超声心动检查,将伴有中重度功能性三尖瓣反流的患者作为研究对象（12例）,于手术后3个月及6个月复查二维超声心动图,对比分析手术前后超声心动图数据,从而评判导管射频消融术后维持窦性心律对功能性三尖瓣反流的影响及逆转右心重构的作用.结果 导管射频消融术后3个月和6个月右心房上下径[（54.13±6.06）mm比（49.72±5.96）mm,P=0.001;（54.13±6.06）mm比（48.37±5.53）mm,P=0.001]、右心房左右径[（39.29±6.38）mm比（35.09±3.15）mm,P=-0.023;（39.29±6.38）mm比（33.86±2.97）mm,P=0.014]、右心室基底部横径[（34.65±4.51）mm比（32.58±3.93）mm,P=0.033;（34.65±4.51）mm比（31.40±3.59）mm,P=0.043]、三尖瓣反流面积[（7.30±1.37）mm^2比（3.18±2.10）mm^2,P=0.001;（7.30±1.37）mm^2比（1.52±1.92）mm^2,P=0.001]均有所减少,差异有统计学意义.结论 导管射频消融术可以改善非瓣膜病性房颤患者功能性三尖瓣反流的程度,逆转右心重构,疗效确切.     

二维多普勒超声心动图研究右室起搏患者三尖瓣反流

用二维多普勒超声心动图对27例正常人、40例已安置有右室永久性起搏器患者及6例安置起搏器前后患者的三尖瓣反流(TR)进行了对比研究。结果表明,48.0%正常人测到TR,40例右室起搏患者中,92.5%发生TR,重度反流占10.0%;随着安置时间的延长,TR发生率及程度加重;导致TR的主要原因为起搏导管阻碍瓣膜关闭。     

孤立性三尖瓣反流的病因、预后及影像学评估

孤立性三尖瓣反流是指单纯三尖瓣解剖学异常引起的反流。常见于先天性心脏病、风湿性瓣膜病、感染性心内膜炎、类癌心脏病、服用食欲抑制剂、医源性损伤、外伤、三尖瓣脱垂、心肌梗死等。三尖瓣反流的严重程度与预后呈负相关。评估三尖瓣反流应包括三尖瓣形态、跨瓣血流以及左右心室形态、功能等三方面指标，常用的无创影像学方法为超声心动图和心脏磁共振。     

三尖瓣血流E波峰值速度与三尖瓣反流程度相关

应用超声心动图对三尖瓣反流程度进行分级较困难,因为目前尚无达成共识的简便方法。现前瞻性研究以色列拉宾医学中心常规经胸超声心动图检出的115例三尖瓣反流患者中,三尖瓣血流E波峰值速度与三尖瓣反流程度的关系。除外标准:三尖瓣狭窄,安置经静脉心脏起搏器,置入人工三尖瓣者     

孤立性三尖瓣反流的病因、预后及影像学评估

孤立性三尖瓣反流是指单纯三尖瓣解剖学异常引起的反流。常见于先天性心脏病、风湿性瓣膜病、感染性心内膜炎、类癌心脏病、服用食欲抑制剂、医源性损伤、外伤、三尖瓣脱垂、心肌梗死等。三尖瓣反流的严重程度与预后呈负相关。评估三尖瓣反流应包括三尖瓣形态、跨瓣血流以及左右心室形态、功能等三方面指标,常用的无创影像学方法为超声心动图和心脏磁共振。     

实时三维超声心动图定量评价左心瓣膜病变伴随的功能性三尖瓣反流的可行性研究

目的:探讨实时三维超声心动图(RT-3DE)定量评价左心瓣膜病变伴随的功能性三尖瓣反流(FTR)的可行性.方法:100例拟行瓣膜置换术的左心瓣膜病变患者,于术前、术后1周、术后6-9个月行超声心动图检查,采集73例功能性三尖瓣反流的二维超声心动图(2DE)及RT-3DE图像,测量并计算瞬时三尖瓣最大反流容积、右心房容积、三尖瓣最大反流面积/右心房面积、三尖瓣最大反流容积/右心房容积.对相关指标进行配对t检验和直线相关分析.结果:三尖瓣最大反流容积、右心房容积及两者比值的2DE和RT-3DE测值差异有统计学意义(P＜0.05);但两种测值间具有较好的一致性和相关性,r=0.867,0.897.结论:RT-3DE定量功能性三尖瓣反流是可行的,用于临床评价功能性三尖瓣反流更为合理.     

Isolated rheumatic severe tricuspid regurgitation

Severe isolated tricuspid regurgitation (TR) is very rare, with most cases of TR being functional and secondary to pulmonary hypertension from left heart pathologies. We report an unusual case of a young Nigerian male, who presented to us with dyspnea, repeated hospital admissions for heart failure, and a childhood history of rheumatic fever. Echocardiogram showed massively dilated right atrium and ventricle, noncoaptation of thickened tricuspid valve with torrential free tricuspid regurgitation. Other valves were normal. Cardiac MRI showed normal right ventricular function and viability. Patient underwent tricuspid valve replacement with 35‐mm St. Jude valve.     

Doppler echocardiography in the evaluation of tricuspid stenosis

Seventeen patients (12 with native and five with prosthetictricuspid valves) with tricuspid stenosis were studied by Dopplerechocardiography followed by cardiac catheterization within24 h. The mean tricuspid diastolic pressure gradient was calculatedusing the modified Bernoulli equation. Tricuspid valve area(TVA) was calculated by the pressure half-time method (TVA =190 divided by pressure half-time). Data from Doppler echocardiographyand cardiac catheterization were compared. The Doppler-derivedtricuspid mean diastolic gradient was 1.9–9.9 mmHg (average5.3±2.5 mmHg), which correlated moderately well withthe catheterization-determined mean diastolic gradient of 2–17mmHg(average 7.3 ±4.0 mmHg), R = 0.74, standard error ofthe estimate (SEE) 1.70 mmHg, Y=0.45 x+2.00,P<0.001. TheDoppler-derived TVA was 0.56–1.58 cm² (average 1.06±0.32cm²), which correlated well with the catheterization-determinedTVA of 0.4–2.2cm² (average 1.06±0.46 cm²), R=0.81,SEE=0.20cm², Y=0.56 x+0.46, P<0.001. Of 12 patients undergoingright ventricular angiography, the angiographic and Dopplergrades of tricuspid regurgitation matched exactly in six anddiffered by one grade in the remaining six. This study demonstratedthat Doppler echocardiography compares very well to cardiaccatheterization in the quantification of tricuspid stenosisand in the assessment of concomitant tricuspid regurgitation.     

BalMedic成形软环治疗功能性三尖瓣反流的疗效观察

目的 研究BalMedic成形软环治疗三尖瓣功能性反流的临床效果.方法 同顾性分析18例行左心瓣膜手术同时应用BalMedic成形环行三尖瓣成形术治疗三尖瓣功能性反流患者的临床资料,着重分析手术方法和手术结果,通过胸心脏B超榆查来评估手术前后三尖瓣反流情况.结果 共植入27#成形环13枚(72%,13/18),29#成...     

Atrial functional tricuspid regurgitation: An underappreciated cause of secondary tricuspid regurgitation

Secondary tricuspid regurgitation (TR) caused by right ventricular enlargement in the setting of left heart disease/pulmonary hypertension has been well described. In contrast, that associated with right atrial enlargement—atrial functional TR (AF‐TR)—remains largely underappreciated. AF‐TR most often occurs in the setting of lone atrial fibrillation, although it is also seen in its absence (idiopathic AF‐TR). Several recent studies have found that the prevalence, hemodynamic significance, and prognosis of AF‐TR are not inconsequential, suggesting increased physician awareness of this novel clinical entity is warranted. This article discusses the pathogenesis, echocardiographic findings, and treatment of this underappreciated cause of secondary TR.     

计算机技术定量分析三尖瓣返流患者右室收缩和舒张功能的研究

本研究对３０例三尖瓣返流患者同步进行了多普勒超声心动图和右心导管检查，应用计算机软件程序对三尖瓣返流频谱曲线进行微分处理。结果表明，两种技术测量的右室压力最大上升速率、右室心肌最大生理缩短速度、右室压力最大下降速率以及右室心肌松驰时间常数均高度相关（ｒ分别为０．９３，０．８６，０．９４，０．９５），表明三尖瓣返流压差法能够无创性估测右室收缩和舒张功能，应用计算机软件程序能够使测量方法简便、准确。