改良三尖瓣成形环技术治疗继发性三尖瓣关闭不全的中期效果

目的 总结改良三尖瓣环成形技术的近、中期疗效.方法 2002年8月至2007年12月,连续158例左心系统瓣膜病变合并三尖瓣关闭不全患者行三尖瓣环成形手术治疗.158例患者中,男74例,女84例;年龄(47.3±12.0)岁.肺动脉收缩压(53.4±19.8)mm Hg(1 mm Hg =0.133 kPa).三尖瓣轻度反流患者66例(41.8％),中度反流54例(34.2％),重度反流38例(24.0％).术前轻度反流组三尖瓣瓣口直径(38.2±4.9) mm,中度反流组(47.0±11.6) mm,重度反流组(44.5±8.9) mm,P＜0.001.轻、中、重度反流组左心室射血分数分别为0.59±0.08、0.59±0.06、0.58±0.09,差异无统计学意义,P=0.73.三尖瓣成形手术适应证为中-大量三尖瓣反流或中度以上肺动脉高压病例(肺动脉收缩压＞40 mm Hg).应用Cosgrove-Edwards成形环进行改良三尖瓣环成形术,在经典术式基础上尽可能采用小号三尖瓣成形环和隔瓣部分固定技术.通过多元回归和生存分析方法,评价近、中期疗效.结果术后少、中、大量反流组病例三尖瓣环缩小值分别为(12.4±5.6) mm、(20.8±11.5)mm、(18.6±8.3) mm,三尖瓣环少量反流组瓣口直径环缩幅度显著小于中、重度反流组(P＜0.001).术后早期中量反流组1例患者死亡.术后157例患者获得中期随访,随访中位数为49.1个月.随访期间3例出现三尖瓣中、大量反流,其中,术前中度反流组1例,重度反流组2例,组间差异无统计学意义,P=0.06.中期随访中9例死亡,其中术前轻度反流组3例,中度反流组2例,重度反流组4例,组间差异无统计学意义,P=0.10.结论 应用Cosgrove-Edwards成形环进行改良三尖瓣环成形术治疗左心系统瓣膜病变合并三尖瓣关闭不全中期效果良好.     

风湿性三尖瓣病变的瓣膜成形术

作者报道４９例风湿性三尖瓣病变的成形术，占同期三尖瓣病变的１３．５％。以狭窄为主２６例，以关闭不全为主２３例；后瓣与隔瓣交界融合９例，前瓣与隔瓣交界融合７例，前后瓣交界融合５例，混合存在５例。合并瓣下结构病变１７例，联合其它心脏瓣膜手术：双瓣置换３３例，二尖瓣置换１５例，主动脉瓣置换１例。手术采用闭合后瓣的二叶化手术或节段性ＤｅＶｅｇａ成形术；交界融合切开加瓣环成形术；瓣下结构粘连分离加腱索乳头肌劈开加瓣环成形术。术后早期死亡３例，其余４６例术后随访２个月～７年（平均４．２年）。术后半年超声复查右房均有不同程度的缩小，三尖瓣轻到中度反流８例，无反流３８例（８２．６１％），心功能转为Ｉ级３４例、ＩＩ级１０例、ＩＩＩ级２例，无晚期死亡。对手术选择的理论依据进行了讨论     

三尖瓣脱垂的外科治疗

目的探索应用三尖瓣脱垂瓣缘折叠缝合技术治疗三尖瓣关闭不全的外科方法和疗效。方法1997年4月至2006年3月为6例先天性三尖瓣前叶腱索缺如和3例外伤性腱索断裂的患者实施了外科矫治手术,其中男性6例,女性3例,年龄8～57岁。术前9例患者均有三尖瓣重度关闭不全,右心室前后径均值为(43.6±4.2)mm。5例患者心功能为Ⅲ级,4例为Ⅳ级。连续对折缝合脱垂的三尖瓣瓣缘,折叠缝合脱垂瓣叶相对应的瓣环,并用成形环固定成形后三尖瓣瓣环。结果9例患者术后恢复顺利,无死亡。术后超声心动图检查示:6例患者三尖瓣对合良好无反流,3例患者有少量反流。所有患者术后右心室前后径均显著减小,术后均值为(24.0±1.8)mm,与术前相比差异有统计学意义(P<0.01)。3例房颤心律的患者均转为窦性心律。患者随访1～109个月,除1例患者外,其他8例患者三尖瓣成形效果稳定。8例患者心功能为Ⅰ～Ⅱ级,1例为Ⅲ级。结论应用三尖瓣脱垂瓣叶及其相对应的瓣环折叠技术,可有效修复先天性三尖瓣部分腱索缺如和胸外伤后三尖瓣腱索断裂所致的三尖瓣重度关闭不全。     

成形环在三尖瓣成形术治疗三尖瓣关闭不全中的临床应用

目的 观察利用人工瓣环行三尖瓣成形术治疗风湿性心脏病继发性三尖瓣关闭不全患者的近、中期效果. 方法 2009年12月至201 1年9月四川省简阳市人民医院共有41例风湿性心脏病患者接受左心瓣膜置换术并同期置人人工瓣环行三尖瓣成形术,其中男12例、女29例,平均年龄49(21～67)岁.术前合并心房颤动38例,合并左心房血栓13例;三尖瓣微量反流2例,轻度反流5例,中度反流11例,重度反流23例;行二尖瓣置换术28例,二尖瓣+主动脉瓣置换术13例.所有患者术后均经门诊随访(术后每3个月门诊复查1次),术后6个月复查心脏彩色超声心动图观察三尖瓣反流情况. 结果 术后心功能较术前改善2～3级,心功能Ⅰ级和Ⅱ级共39例,差异有统计学意义(P＜0.05);全组患者随访6～27个月,随访期内无死亡.术后6个月心脏彩色超声心动图检查提示:三尖瓣反流程度较术前明显减轻,微量反流和轻度反流共39例,差异有统计学意义(P＜0.05);术后右心测值较术前明显缩小,右心室横径由术前20 mm降至术后17mm,差异有统计学意义(P＜0.05). 结论 利用人工瓣环行三尖瓣成形术治疗继发性三尖瓣关闭不全,其近、中期疗效明确,远期疗效需要继续随访观察.     

风湿性三尖瓣器质性病变的外科治疗

目的：根据三尖瓣不同类型病变,探讨对三尖瓣器质性病变比较合理的处理方法。方法：根据超声心动图检查及手术探查结果进行分析,依据不同病理改变决定手术方式,行三尖瓣器质性病变瓣膜成形术和瓣膜置换术53例。以瓣环扩大、瓣叶增厚、关闭不全为主的患者采用改良Kay法或节段性DeVega成形术;交界粘连融合以狭窄为主则切开交界融合,切开处以小垫片缩环,交界对拢缝组成统一瓣;成形失败者行三尖瓣置换术。结果：采用改良Kay法或节段性DeVega成形术43例,切开粘连交界对拢缝合5例,置换生物瓣1例,机械瓣4例,术后早期死亡3例。随访50例,随访时间5个月－9年,随访率为94％,其中1例5年后死于心力衰竭。超声心动图示三尖瓣无反流41例,轻至中度反流8例。心功能恢复到Ⅰ-Ⅱ级44例,Ⅲ级5例。结论;三尖瓣器质性病变绝大部分均可采用瓣膜成形术,三尖瓣置换术的远期效果较为满意。     

心脏瓣膜置换术同期行三尖瓣成形术治疗体会

目的探讨在二尖瓣和/或动脉瓣置换术同期行三尖瓣成形术的合理手术指征、方法及围术期的处理。方法回顾分析三尖瓣成形术治疗三尖瓣关闭不全136例,其中行Devega成形65例,人工环成形48例,Key,s成形23例。同时行二尖瓣置换94例,二尖瓣＋主动脉瓣置换42例。结果术后院内死亡5例,死亡率3.6%;迟发性心包填塞6例经心包引流治愈。术后随访2个月～8年,获访112例,5例死于顽固性心力衰竭,其余心功能明显改善。心脏超声示右心房及右心室较术前明显缩小。27例仍有轻中度返流。结论在瓣膜置换术中据三尖瓣环扩大的部位及返流程度,选择不同的成形方式对于三尖瓣关闭不全疗效满意。围术期及术后加强强心、利尿及扩血管治疗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。     

以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察

目的初步观察采用三尖瓣瓣环径作为三尖瓣成形术指征是否有助于减少二尖瓣置换术（MVR）患者术后中重度三尖瓣反流（TR）的发生。方法选择2005年4月至2006年6月期间我科56例术前无或轻度TR的MVR患者纳入研究。以三尖瓣瓣环径/体表面积≥21mm/m2将患者分为三尖瓣成形组（TA组）和非三尖瓣成形组（NTA组）。TA组：22例,男8例,女14例;年龄45.0±7.7岁;三尖瓣瓣环径36.8±3.8mm,体表面积1.57±0.15m2;心功能分级（NYHA）级18例,～级4例;窦性心律2例,心房颤动20例。NTA组：34例,男9例,女25例;年龄42.9±11.0岁;三尖瓣瓣环径28.5±4.4mm,体表面积1.58±0.13m2;心功能分级级28例,～6例;窦性心律9例,心房颤动25例。TA组患者采用Kay法施行三尖瓣成形术。术后随访及术后6个月完成超声心动图检查。结果56例患者术后均康复出院。术后随访11.0±2.4个月,除2例外54例患者完成术后6个月超声心动图复查。两组患者一般临床特征比较差异无统计学意义（P〉0.05）。与NTA组比较,术前TA组患者右房径（49.3±7.0mm）、三尖瓣瓣环径较大（36.8±3.8mm）,有三尖瓣反流的患者较多（P〈0.05）,术后TA组患者右房径（44.1±8.9mm）、三尖瓣瓣环径（28.9±6.1mm）明显缩小,三尖瓣反流程度明显改善（P〈0.05）。NTA组患者术前、术后右房径、三尖瓣瓣环径和三尖瓣反流程度变化不明显（P〉0.05）,有3例患者出现TR。结论对术前无或轻度TR的MVR患者,采用三尖瓣瓣环径作为三尖瓣成形手术指征可能有助于减少这些患者术后中-重度TR的发生。     

继发性三尖瓣反流危险因素分析及外科治疗

目的评价左心瓣膜置换术后继发性三尖瓣反流（TR）的危险因素，探讨手术方法，降低TR发生率。方法1987年1月至2005年12月，资料完整并获得随访的左心瓣膜置换术病例290例，其中单纯左心瓣膜置换217例，左心瓣膜置换并三尖瓣成形73例，73例中31例行DeVega成形术（A组），32例行Dacron补片条三尖瓣成形术（B组），10例行自体心包片加宽三尖瓣前瓣成形术（C组）。使用t检验、卡方检验或Fischers精确概率法及多因素非条件logistic逐步回归分析，评估单纯左心瓣膜置换术后继发性TR的危险因素，随访观察三尖瓣成形术（TVP）后病人心功能、左室射血分数（LVEF）、肺动脉压（PAP）及三尖瓣反流情况。结果单因素分析显示心房纤颤、巨大左房、左心瓣膜病病程长、左心功能低下（LVEF〈0.50）、右房增大（≥50mm）、三尖瓣风湿性病变及单纯二尖瓣病变是继发性TR进行性加重的危险因素；多因素分析显示心房纤颤、巨大左房、左心瓣膜病病程长及三尖瓣风湿性病变是继发性TR进行性加重的危险因素；远期随访显示，B组心功能改善明显优于A组，TR程度明显低于A组，C组术后无1例发生TR。结论对术前伴有心房纤颤、左房增大、左心瓣膜病病程长、三尖瓣风湿性病变者，术中应仔细检查三尖瓣的功能状态和瓣环大小，以决定是否同期行三尖瓣成形术；对于三尖瓣瓣环扩张者，Dacron补片条三尖瓣成形术亦是治疗继发性TR的经济而有效方法；对于三尖瓣瓣环不扩张、前瓣较小的TR者，适宜采用自体心包片加宽前瓣治疗，可获得满意的疗效。     

三尖瓣硬质人工瓣环成形术的中期效果评价

目的评价硬质三尖瓣成形环对三尖瓣成形的中期效果。方法对风湿性心瓣膜病伴中、重度三尖瓣关闭不全患者应用硬质Carpentier三尖瓣成形环行三尖瓣成形术15例(人工瓣环成形组),术前三尖瓣每搏反流量31.9±7.6ml;并与同期16例行Kay及DeVega三尖瓣成形术患者(对照组)进行比较,对照组术前三尖瓣每搏反流量25.3±6.9ml。术后对所有患者均进行随访,用彩色超声心动图观察术后三尖瓣反流情况。结果两组均无手术死亡,术后心功能分级均较术前提高1～2级。出院前和术后6个月,两组患者三尖瓣反流量差别无统计学意义,术后随访1、2、3年,人工瓣环成形组三尖瓣反流量小于对照组(P<0.05,0.05,0.01)。结论应用硬质三尖瓣成形环对三尖瓣进行成形,其中期效果明显优于Kay和DeVega成形术。     

自体心包“C”形环三尖瓣成形术疗效观察

目的观察自体心包"C"形环对功能性三尖瓣关闭不全行三尖瓣成形术的疗效。方法 2009年3月至2011年1月贵州省人民医院行三尖瓣成形术11例,男5例,女6例;年龄32～57(43.80±12.20)岁。三尖瓣轻度反流3例,中度反流7例,重度反流1例。同期行二尖瓣置换术和/或主动脉瓣置换术和/或左心房血栓清除。术中用0.8%戊二醛固定15 min的自体心包片制作"C"形环,间断褥式缝合"C"形环至三尖瓣瓣环行三尖瓣成形术。随访患者心功能、超声心动图指标。结果 11例患者住院期间无死亡,住院时间15～28(21.10±3.80)d。11例均获得随访,随访时间8～28(18.50±7.00)个月。随访期间无死亡,无因三尖瓣反流或狭窄需再次手术者。术后有10例检查仍有三尖瓣反流,其中轻度反流9例,轻-中度反流1例,无重度反流。三尖瓣反流程度较术前降低(Z=-2.81,P<0.05)。术前与术后右心室内径[(19.95±5.11)mm vs.(21.57±12.81)mm,P=0.705]、右心房内径[(37.55±6.79)mm vs.(35.55±5.22)mm,P=0.317]比较差异无统计学意义。结论自体心包"C"形环三尖瓣成形术效果满意。     

Tricuspid annuloplasty--modified technique

A modification of the DeVega's tricuspid annuloplasty (TAP) in the treatment of tricuspid regurgitation (TR) is described. Using a double-ended 2-0 Ethibond suture buttered with a Teflon felt pledget, a double suture line is begun at the center of the annulus of the anterior tricuspid valve leaflet. The two suture lines 2 to 3 mm apart are run around the edge of the annular ring of the anterior and posterior tricuspid valve leaflets, going over the posteroseptal commissure by 1.5 cm. A tiny piece of Teflon felt is placed at the end of the sutures. The annulus is narrowed to sungly allow passage of a prove with a diameter of 28 or 30 mm. The tricuspid function is assessed by injecting saline into the right ventricle through the right atrium. Between March 1986 and July 1989, 28 patients with functional TR secondary to mitral valve diseases have been operated on by this technique. There are one early and one late deaths, none being related to tricuspid valve annuloplasty. All 26 survivors had a significant drop in right atrial pressure and an associated improvement in clinical status. Follow-up of the 27 patients who survived this TAP ranges from 2 to 38 months (mean 17 months). This annuloplasty is a safe, effective and readily teachable method for the surgical management of TR.     

Surgical repair of isolated congenital tricuspid regurgitation with artificial chordae--a case of two year-follow up]

Isolated congenital tricuspid regurgitation derived from primary dysplasia of the valvular apparatus is a rare cardiac abnormality. A 23-year-old woman was first diagnosed to have an isolated tricuspid regurgitation during infancy and was followed up at our hospital. She developed progressive cardiomegaly at the age of 22 years. The chest roentgenogram at the time of admission revealed marked cardiomegaly with a cardiothoracic ratio of 64%. Despite the severe regurgitation of the tricuspid valve, the catheter examination disclosed v and mean pressures of the right atrium of 9 mmHg and 5 mmHg, respectively. The operative findings revealed a markedly dilated tricuspid annulus of 45 mm in diameter (157% of normal) and fragile and redundant valve leaflets, anterior leaflet in particular. Anterior papillary muscle was absent without any vestige thereof. Chordae tendinae of the anterior and posterior leaflets were absent and those of the septal leaflet were attached to the ventricular septum. Each commissure was tethered to the ventricular wall by thick and short chordal tissue. The chordal abnormalities were repaired by four artificial chordae of 4-0 ePTFE suture and an annuloplasty with Carpentier-Edwards ring (36 mm) was added. She recovered uneventfully and was discharged on postoperative day 30. A follow-up echocardiography at 2 years after surgery showed excellent function and trivial regurgitation of the valve. No evidences of thrombus or calcification of the artificial chordae were detected. This experience draws us to conclude that the artificial chordal replacement is one of the useful surgical options for the repair of isolated congenital tricuspid regurgitation.     

Surgical repair of isolated congenital tricuspid regurgitation with artificial chordae —A case of two year-follow up—

Isolated congenital tricuspid regurgitation derived from primary dysplasia of the valvular apparatus is a rare cardiac abnormality. A 23-year-old woman was first diagnosed to have an isolated tricuspid regurgitation during infancy and was followed up at our hospital. She developed progressive cardiomegaly at the age of 22 years. The chest roentgenogram at the time of admission revealed marked cardiomegaly with a cardiothoracic ratio of 64%. Despite the severe regurgitation of the tricuspid valve, the catheter examination disclosed ν and mean pressures of the right atrium of 9 mmHg and 5 mmHg, respectively. The operative findings revealed a markedly dilated tricuspid annulus of 45 mm in diameter (157% of normal) and fragile and redundant valve leaflets, anterior leaflet in particular. Anterior papillary muscle was absent without any vestige thereof. Chordae tendinae of the anterior and posterior leaflets were absent and those of the septal leaflet were attached to the ventricular septum. Each commissure was tethered to the ventricular wall by thick and short chordal tissue. The chordal abnormalities were repaired by four artificial chordae of 4-0 ePTFE suture and an annuloplasty with Carpentier-Edwards ring (36 mm) was added. She recovered uneventfully and was discharged on postoperative day 30. A follow-up echocardiography at 2 years after surgery showed excellent function and trivial regurgitation of the valve. No evidences of thrombus or calcification of the artificial chordae were detected. This experience draws us to conclude that the artificial chordal replacement is one of the useful surgical options for the repair of isolated congenital tricuspid regurgitation.     

New developments for reconstruction of the tricuspid valve

Four patients with multivalvular disease underwent tricuspid valve repair by a new technique. The anterior and posterior leaflets adjacent to the incompetent commissure were separated from the anulus to allow coaptation of the three leaflets in the middle. In conjunction with the commissure, half of the isolated anulus was then excluded with a continuous 3-0 Ti-Cron suture. A 5-0 Prolene suture was then used to readapt the cut edges of the leaflets to the shortened anulus. In this way it was possible to reduce the circumference of the anulus selectively, without reducing the active area of the leaflets. All patients survived. A significant decrease in the mean right atrial pressure without evidence of regurgitation could be recorded in all patients. Postoperative morphometric echocardiographic evaluation of the tricuspid valve showed a maximal anulus diameter even larger than in normal hearts. No inflow obstruction was present. The systolic shortening of the anulus ranged within normal limits. The opening amplitude of the leaflet as well as the slope of the ejection fraction were not decreased. No significant regurgitation was evidenced by contrast echocardiograms. One to 3 months postoperatively, no annuloplasty dehiscence has occurred.     

A single-size band, 50mm long, for tricuspid annuloplasty.

A technique for tricuspid annuloplasty is presented, using a flexible 50mm long band, where the annular circumference is reduced to a fixed value of 78.5mm (circumference of #25mm sizer). From June to February 2007, 15 consecutive patients with tricuspid regurgitation (TR) underwent tricuspid repair using this technique. The first suture is passed at the level of the anteroseptal commissure, the last one in the zone of the septal annulus, 28.5mm from the first one. The remaining sutures are passed as usual. All the sutures are then adapted to a 50mm long band. After a mean of 5.4 months from surgery, all patients are alive and asymptomatic. One patient showed residual 2/4 TR, due to enlarged RV with high pulmonary pressure despite a well functioning mitral prosthesis. Mean gradient across the tricuspid valve was 2.5+/-0.4mmHg. This technique for tricuspid repair is simple and reliable, providing effective and reproducible results.     

Left ventricular-right atrial communication following tricuspid annuloplasty.

A 71-year-old woman was admitted for examination of a heart murmur and anemia. She had a history of mitral valve replacement and tricuspid ring annuloplasty 8 months prior to admission. A new systolic murmur was heard, and echocardiography showed a high-velocity jet originating from the left ventricular outflow tract to the right atrium and a small defect between the left ventricle and the right atrium. No periprosthetic leaks were detected in the mitral position. At operation, a communication just beneath the detached prosthetic ring at the anterior-septal commissure of the tricuspid valve, and a jet of bright red blood entering the right atrium through the defect at the atrial septum just cephalad to the commissure, were found. After removing the ring, the defect was closed using a mattress suture. In this case, the tricuspid annuloplasty ring was probably placed on the atrio-ventricular portion of the membranous septum, rather than the tricuspid annulus, at the antero-septal commissure of the tricuspid valve in the previous operation, and its dehiscence may have created a tear in the atrio-ventricular membranous septum, leading to left ventricular-right atrial communication.     

Repair of flail leaflet of the tricuspid valve by a simple cusp remodeling technique

BACKGROUND AND AIM: The approach of repairing tricuspid valve insufficiency caused by congenital lack of chordae or traumatic rupture of chordae is often complicated and difficult. We try to present an alternative method and midterm results. METHODS: Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 +/- 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring. RESULTS: All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 +/- 12.5 mm to a mean of 23.6 +/- 5.3mm (p < 0.01). Mean follow up was 50 +/- 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well. CONCLUSION: The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae.     

Posterior annular plication: tricuspid valve repair in Ebstein's anomaly

BACKGROUND: Nonneonatal Ebstein's anomaly is a rare congenital anomaly for which numerous operative techniques have been described to repair the aberrant tricuspid valve, exclude the atrialized right ventricle, and address right heart dysfunction. We reviewed short-term outcomes in surgical patients treated by a simplified operative technique. METHODS: Our operative approach to Ebstein's anomaly is approximation of the anteroposterior commissure to the remnant septal leaflet with closure of the cul-de-sac longitudinally. Plication of the atrialized right ventricle (1 patient) and a bidirectional cavopulmonary connection (2 patients) were performed only if necessary. All patients were followed postoperatively by their cardiac surgeon and cardiologist. RESULTS: Seven patients with a mean age of 39 years (range, 3.6 to 63.8 years) underwent repair. Preoperatively all patients had 4+ tricuspid valve regurgitation and were New York Heart Association class III. Mean postoperative hospital stay was 7 +/- 2 days (range, 4 to 11 days). Mean follow-up is 42 +/- 18 months (range, 7 to 58 months). At last follow-up 5 patients are New York Heart Association class I and average tricuspid valve regurgitation is mild. CONCLUSIONS: Plication of the posterior annulus without plication of the atrialized right ventricle, resiting the tricuspid valve, or performing prophylactic cavopulmonary connection appears to be a reasonable operative approach to nonneonatal Ebstein's anomaly. Long-term follow-up of this cohort is necessary to determine the durability of such a surgical approach.     

"缘对缘"三尖瓣成形在纠治残留三尖瓣关闭不全的应用

目的总结“缘对缘”三尖瓣成形方法治疗重度残留三尖瓣关闭不全的经验。方法19例常规三尖瓣成形术后仍有重度残留三尖瓣关闭不全者接受“缘对缘”三尖瓣成形术。三尖瓣关闭不全的病因包括：风湿性心脏病7例、先天性心脏病8例、创伤性及退行性变各2例。结果住院死亡1例，9例术后无或仅有微量三尖瓣关闭不全，10例术后轻度三尖瓣关闭不全。随访3～60个月，平均36．6个月，16例为微量到轻度三尖瓣关闭不全，2例为轻度到中度三尖瓣关闭不全。结论“缘对缘”三尖瓣成形是纠治重度残留三尖瓣关闭不全的一种有效的辅助方法。