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。     

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     

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.     

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...     

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。     

Severe tricuspid regurgitation due to entrapment of the anterior leaflet of the valve by a permanent pacemaker lead: role of real time three-dimensional echocardiography

Pacemaker leads may impair tricuspid valve coaptation and they are a well-known cause of mild tricuspid regurgitation. Occasionally, right ventricular leads worsen tricuspid regurgitation over time and patients develop late-onset symptoms of right-sided heart failure. The exact mechanism of this clinical entity is rarely identifiable by 2D-echocardiography only. This case report details a patient with severe tricuspid regurgitation secondary to immobilization of the anterior leaflet of the tricuspid valve by a permanent ventricular pacing lead. The mechanism of regurgitation was clarified by real time three-dimensional echocardiography that showed the location of the ventricular lead and its interference with the tricuspid valve.     

Predictors for the development of severe tricuspid regurgitation with anatomically normal valve in patients with atrial fibrillation

Background and Aims: Atrial fibrillation (AF) may be a risk factor for severe functional tricuspid valve regurgitation (FTR). We aimed to determine the predictors of severe FTR in patients with AF. Methods and Results: From our echocardiographic laboratory database, we searched for and reviewed the medical records of consecutive patients with severe FTR and AF seen at Mayo Clinic in Arizona from 2002 through 2009. Our search identified 42 patients who met all inclusion criteria. These patients (cases) with severe FTR and AF were compared with 38 patients (controls) with AF who had no greater than mild tricuspid regurgitation. Case patients with severe FTR were older than controls (mean, 81 years vs. 76 years; P < 0.001) and more frequently had chronic AF (69% vs 26%; P < 0.001). Mean right atrial volume (86 mL/m² vs 46 mL/m²; P < 0.001), right ventricular volume (42 mL ± 33 mL vs 22 mL ±8 mL; P < 0.001) and tricuspid annular diameter (3.6 cm vs 3.0 cm; P < 0.001) were larger in cases than in controls. Patients with severe FTR also had a higher prevalence of right‐sided heart failure (69% vs 16%; P < 0.001). After adjusting for age and gender, right atrial and right ventricular volumes were independent predictors for the development of severe FTR in patients with AF (odds ratio, 1.7 [95% CI, 1.3–2.8] for every 10 mL/m² increase in right atrial volume; P = 0.0002 and odds ratio, 3.1 [95% CI, 1.5–8.9] for every 10 mL increase in right ventricular volume; P = 0.0002). Conclusions: Severe FTR occurs in older patients with chronic AF as a result of marked right atrial and right ventricular dilatation; and enlargement of the tricuspid annulus in the absence of pulmonary hypertension. More importantly, severe FTR leads to increased prevalence of right‐sided heart failure underscoring the nonbenign nature of chronic AF. (Echocardiography 2012;29:140‐146)     

Traumatic tricuspid papillary muscle and chordae rupture: emerging role of three-dimensional echocardiography

We describe a patient with blunt traumatic chest injury in whom three-dimensional transthoracic echocardiography (3DTTE) confirmed the findings of a flail anterior tricuspid valve leaflet and ruptured anterior papillary muscle seen on two-dimensional transthoracic echocardiography, and in addition identified multiple chordae tendinae rupture of the posterior leaflet. Open heart surgery confirmed the findings. The emerging role of 3DTTE in defining the true extent of traumatic tricuspid valvular injury is highlighted .     

Diagnosis of tricuspid regurgitation. Sensitivity of Doppler ultrasound compared with contrast echocardiography

Fifty-one patients underwent Doppler studies of tricuspid flowand 2-D derived M-mode studies of the inferior vena cava (IVC)during upper extremity contrast injections. Tricuspid regurgitation(TR) was diagnosed with Doppler when reverse flow in systolewas recorded at and behind the closure level of the tricuspidvalve. TR was diagnosed with contrast ehocardiography (CE) whencontrast appeared in the IVC between the onset of the QRS complexand the end of the T-wave of the ECG. Of the 49 patients whohad TR diagnosed with Doppler, contrast was recorded in theIVC in 46, but only 18 (37%) fulfilled the criterion for a positiveCE study. When the severity of the TR was semiquantitated withDoppler, CE diagnosed 1 of 25 mild, 5 of 11 moderate, and 12of 13 severe regurgitations. When systolic contrast appearancein the IVC after the peak of the R-wave was used as the criterionfor a positive contrast study, CE missed 2 of 13 severe regurgitations.In the 24 catheterized patients the CE study was positive onlywhen an abnormal V-wave in the right atrial pressure curve waspresent. Doppler is a more sensitive method than CE for diagnosingTR and is more readily applied.     

Severe tricuspid regurgitation 14 years after diagnosis of "transient neonatal tricuspid regurgitation"

A 14 year old girl presented with severe tricuspid regurgitation after she was diagnosed with "transient tricuspid regurgitation of the newborn". In the neonatal period she had presented with severe tricuspid regurgitation without an obvious underlying anatomical cause. This spontaneously regressed during the first months of life. She was dismissed from follow up at the age of 5 years after complete normalisation of the clinical and echocardiographic examination. The subsequent evolution and management of the patient, as well as the possible pathogenesis responsible for the unusual clinical course, is discussed. This case stresses the importance of long term follow up of patients with transient tricuspid regurgitation.


     

Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area

We evaluated tricuspid regurgitation (TR) by multiple echocardiographic techniques in 93 consecutive patients who underwent standard two-dimensional (2D) and live three-dimensional (3D) transthoracic echocardiography (TTE). TR vena contracta (VC) area was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE dataset. Assessment of VC area by 3D TTE was compared to 2D TTE measurements of the ratio of TR regurgitant jet area to right atrial area (RJA/RAA), RJA alone, VC width, and calculated VC area. VC area from 3D TTE closely correlated with RJA/RAA and RJA alone as determined from 2D TTE measurements. Live 3D TTE color Doppler measurements of VC area can be used for quantitative assessment of TR and offer incremental value for quantification of particularly severe regurgitant lesions.