改良三尖瓣成形术对继发性三尖瓣关闭不全的疗效评价

目的:改良Cosgrove-Edwards(CE)三尖瓣成形术对继发性三尖瓣关闭不全(TI)的临床疗效评价.方法:2002-08至2007-12,连续对51例左心系统瓣膜病变,合并中量以上反流的三尖瓣关闭不全患者进行矫治.2004年以前的患者,采用经典的CE三尖瓣成形术(CE组,η=14);2004年后的患者,采用CE改良术(改良CE组,η=37).51例患者根据术中发现,单纯三尖瓣瓣环扩大的为非风湿者(η=37),同时合并风湿性改变的为风湿者(η,=14).术后50例存活患者获得远期随诊,平均术后随诊时间为(47.08±22.08)个月.结果:三尖瓣成形效果的比较①改良CE组与CE组比较,术后三尖瓣瓣环直径[(26.2±1.7)mm vs(27.7±2.0)mm]、三尖瓣成形环的尺寸(28.1±2.1 V8 29.5±1.5)均缩小,术后1周左右残余三尖瓣中量反流的发生率降低(2.7%V8 21.4%),差异有统计学意义(P<0.05).②风湿者与非风湿者三尖瓣成形结果比较:术前既往瓣膜手术史的发生率高(50.0%VS 13.5%),舒张期三尖瓣流速增加[(1.4±0.4)m/s vs(0.9±0.2)m/s],肺动脉收缩压降低[(54.6±22.2)mmHg vs(72.5±22.6)mmHg,1 mmHg=0.133 kPa],三尖瓣瓣环直径[(37.0±6.2)mm vs(48.2±8.3)Inm]缩小,差异均有统计学意义(P<0.05).结论:改良三尖瓣成形术即选择性小号人工瓣环成形方法,对于继发性TI治疗效果良好;同时继发性,TI是一种进行性病变,对其矫治,也应个体化,以期达到最佳的治疗效果.     

三维成形环治疗老年风湿性心脏瓣膜病继发性三尖瓣关闭不全的疗效

目的 比较三尖瓣人工瓣环成形术与缝线成形术对老年风湿性心脏瓣膜病三尖瓣关闭不全患者的成形效果.方法 选择分析2008年1月至2010年7月收治的69例老年风湿性心脏瓣膜病继发性三尖瓣关闭不全患者的临床资料.69例患者分为缝线成形组及人工瓣环组.两组间在术前三尖瓣反流程度、心功能分级(NYHA分级)、肺动脉压力等方面均无明显差异.观察和分析两组患者术前及术后的右心房内径(RAD)、右心室前后径(RVD)、三尖瓣反流面积、心排出量(C0).结果 两组病例均无手术死亡及住院死亡.两组患者组内术后1 w、术后6个月右心房内径、右心室前后径、三尖瓣反流面积较术前有统计学意义(P＜0.05);两组内心排出量术后6个月有统计学意义(P＜0.05);组间三尖瓣反流面积差别有统计学意义(P＜0.05);组间心排出量术后6个月有统计学意义(P＜0.05).术后6个月,缝线成形组出现4例(4/36)三尖瓣重度反流;人工瓣环组未出现三尖瓣重度反流.结论 缝线成形术和人工瓣环成形术均是治疗风湿性心脏瓣膜病继发性三尖瓣关闭不全的有效方法;三尖瓣人工瓣环成形术成形效果优于缝线成形术;左心瓣膜手术同期行三尖瓣成形术可明显增加术后中期心排出量,改善心功能.     

成形环治疗三尖瓣关闭不全的疗效及复发因素分析

目的总结应用成形环治疗功能性三尖瓣关闭不全(FTR)的治疗效果及术后复发危险因素分析。方法以简阳市人民医院心血管外科2012年10月至2015年12月在心脏瓣膜手术同期使用人工瓣环行三尖瓣成形术的124例患者为研究对象,进行单因素和多因素Logistic回归分析,找出影响三尖瓣成形术后复发三尖瓣反流(TR)的危险因素。结果全组患者随访2～5年,随访期末三尖瓣反流构成比明显改善,与术前比较差异有统计学意义(P0.05)。单因素分析显示,术前纽约心脏协会心功能分级(NYHA)3级、术前左心房前后径(LA)、术后右心房横径(RA)、术后右心室内径(RV)、合并心房颤动、瓣环类型、术前三尖瓣反流程度重、术后右心室缩短率与三尖瓣成形术后复发有关;经多因素Lgostic回归分析显示,术前左心房前后径60 mm、术前三尖瓣反流程度重、术后右心室缩短率是三尖瓣成形术后复发三尖瓣反流的独立危险因素。与传统的佰仁思硬环相比,MC3 Edwards成形环能更有效地减少术后三尖瓣反流的发生。结论三尖瓣成形术后三尖瓣反流的发生与患者术前左心房前后径60 mm、术前三尖瓣反流程度重、术后右心室缩短率、瓣环类型有关。应用硬质成形环行三尖瓣成形治疗功能性三尖瓣关闭不全,近中期疗效好。     

预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂

目的:回顾预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂,探讨此手术对二尖瓣脱垂的治疗效果。方法:2008年1月至2012年12月间,回顾性分析北京安贞医院收治的15例二尖瓣脱垂患者,其中男性10例,女性5例,年龄(48.5±3.2)岁,SBE后腱索断裂导致关闭不全2例,单纯腱索断裂导致关闭不全8例,腱索延长导致关闭不全5例。术前超声心动图(TEE)显示:根据Carpentier标准,前叶脱垂10例,后叶脱垂3例,前叶合并后叶脱垂2例。所有患者二尖瓣均为重度关闭不全,反流面积(11.0±0.9)cm2,1例合并三尖瓣重度反流。术前射血分数(EF)平均(64.9±1.9)%,左心室舒张末直径(LVDD)平均(54.9±1.4)mm,左心房直径(LA)平均(42.9±1.7)mm。所有患者均经胸正中切口,体外循环下行预制人工腱索环移植,移植腱索数量为(3.6±0.3)根,腱索长度(15.4±1.5)mm,平均体外循环时间(113±11.7)min,平均主动脉阻断时间(86±9.8)min。3例患者置入SJ成形环,12例患者置入爱德华成形环,1例患者同时行三尖瓣成形术。结果:术后无死亡,无恶性心律失常及其他严重并发症。术后复查TEE显示少量反流3例,微量反流8例,未见反流4例。术后EF平均(60.2±2.9)%,未见明显改变。LVDD平均(46.5±1.1)mm,LA平均(32.9±1.2)mm,均较术前明显改善。随访12~57个月,平均(35.7±4.3)个月,少量反流3例,无或微量反流12例。结论:预制人工腱索环和二尖瓣成形环置入术治疗二尖瓣脱垂近中期效果确切,但是远期预后尚需进一步观察。     

三尖瓣环成形治疗功能性三尖瓣反流245例总结

目的:对比DeVegar成形术与使用成形环三尖瓣环成形方法在治疗中、重度功能性三尖瓣反流中的有效性.方法:自2003-01至2006-01,对245例中度至重度功能性三尖瓣反流的患者施行了三尖瓣环成形手术.其中,115例施行了De-Vegar成形术(DeVegar成形组),130例使用了三尖瓣成形环(成形环组).成形环组选用的成形环包括:Sovering成形环(n=37)、Carpentier-Edwards Classic成形环(n=41)及Edwards MC3成形环(n=52).结果:245例患者围手术期共死亡8名,死亡率3.3%.随访期末,DeVegar成形组与成形环组的左心室射血分数、肺动脉收缩压差异均无统计学意义(P>0.05).DeVegar成形组中度以上三尖瓣反流为21.3%(23/108);成形环组中度以上三尖瓣反流为12.7%(15/118),两组间差异有统计学意义(P<0.01).结论:在功能性三尖瓣反流治疗中,使用三尖瓣成形环进行三尖瓣成形具有更良好的中期疗效.     

功能性三尖瓣关闭不全术后残余返流的危险因素分析

目的：对我院施行的带四个垫片的改良Devega术及佰仁思软成形环成形术治疗功能性三尖瓣关闭不全的112例患者术前和术后4~5年随访时的临床资料进行统计,通过对功能性三尖瓣返流术后残余返流的危险因素进行分析及结合历年文献报道,得出引起三尖瓣术后出现残余返流的高发危险因素,指导临床,减轻术后再次返流,提高手术疗效。方法：采用回顾性临床研究方法,选择分析自2006年1月至2011年7月在中山大学附属江门市中心医院心脏外科因功能性三尖瓣返流行三尖瓣成形术患者共112例,带四个垫片的改良Devega环缩术58例,其中男性26例,女性32例,平均年龄47.32±10.56岁（20~64岁）和使用佰仁思软成形环的54例,其中男性23例,女性31例,平均年龄50.36±6.35岁（32~65岁）,对所有患者术前一周内,术后4~5年随访时均行超声心动图检查及心功能评估,比较两组患者术后4~5年（中期疗效）三尖瓣返流程度变化并分析影响术后的三尖瓣残余返流的危险因素。结果：术后4~5年随访时两组患者三尖瓣返流面积均明显减少,心功能较术前均有显著提高,以随访时三尖瓣中度及重度返流定义为三尖瓣术后残余返流（PRTR）,两组患者共存在术后残余返流12例,其中改良Devega组7例,瓣环成形组5例,对随访出现残余返流的两组患者临床资料进行分析,发现风湿性病变、术后左心射血分数低、术后右心房大、术后三尖瓣环径大、术后肺动脉高压为三尖瓣成形术后出现残余返流的独立危险因素。结论：带四个垫片的改良Devega术及人工瓣环成形术都是治疗功能性三尖瓣返流的有效方法;风湿性病因、术后左心射血分数低、术后肺动脉高压、术后三尖瓣环及术后右房大是术后三尖瓣出现残余返流的危险因素。     

风湿性三尖瓣重度关闭不全外科治疗的疗效分析

目的 评价三尖瓣成形术和三尖瓣生物瓣置换术对治疗风湿性心脏瓣膜病三尖瓣重度关闭不全的临床疗效。方法 回顾性分析我院2014年1月至2016年12月37例风湿性心瓣膜病三尖瓣重度关闭不全患者的临床资料。按不同手术方式将患者分为2组：三尖瓣成形术组（成形组）23例和三尖瓣生物瓣置换术组（置换组）14例。术前两组患者的年龄、性别、心功能分级（NYHA）和三尖瓣返流分级等指标未见统计学差异（P＞0.05）。记录两组患者术前、术后及1年后随访的心功能分级、右心房横径、右心室舒张期末内径和三尖瓣返流面积。结果 术后早期死亡 3 例（均为置换组）,其中低心排2例、心律失常1例;其余患者均痊愈出院。中期随访各组生存率分别为：成形组23/23（100%）、置换组11/14（78.57%）;心功能分级分别为：成形组心功能Ⅰ级13例、Ⅱ级6例、Ⅲ级4例,置换组心功能Ⅱ级7例、Ⅲ级3例、Ⅳ级1例。中期随访各组生存率、心功能分级差异有统计学意义（P＜0.05）,成形组均优于置换组。中期随访三尖瓣返流分级分别为：成形组轻返流22例,中度返流1例,置换组轻度返流11例,差异无统计学意义（P＞0.05）。结论 三尖瓣生物瓣置换术后早期死亡率较高,患者心功能较差;三尖瓣成形术后中期返流程度与三尖瓣生物瓣置换术组相似,并且患者术后心功能良好、生存率较高,值得临床推广。     

人工腱索加二尖瓣成形环治疗非风湿性二尖瓣关闭不全

目的:评估二尖瓣修补治疗非风湿性二尖瓣反流患者的效果。方法:1997-06至2007-06,本组为301例非风湿性二尖瓣关闭不全的患者施行了二尖瓣成形手术,其中162人为男性,139人为女性,117人为中度关闭不全,184人为重度关闭不全。平均年龄为(53.2±16.4)岁(15～72岁)。术前NYHA心功能Ⅱ级55例,Ⅲ级187例,Ⅳ级59例。99例前瓣脱垂(腱索断裂64例,腱索延长35例),后瓣脱垂139例(腱索断裂88例,腱索延长51例),前、后瓣都脱垂63例。患者中7例合并冠心病,1例合并主动脉瓣关闭不全,12例合并三尖瓣关闭不全,11例合并房间隔缺损(继发孔型)。手术均使用可膨胀聚四氟乙烯缝线替换腱索(4CVGore-Tex缝线)。所有患者都有不同程度的二尖瓣环扩张,都常规使用二尖瓣瓣环成形环施行瓣环成形。所有手术都在全麻、中度低温(28℃～31℃)及体外循环下进行。平均主动脉阻断时间为(76.2±12.3)min。结果:1例术后早期死于多脏器功能衰竭,1例患者术后因重度二尖瓣反流导致溶血而施行了机械瓣置换。除死亡和换瓣者以外,所有患者术后都予以随访(2个月～10年)。除1例外,其余的患者术后心功能...     

右室电极植入对心脏结构和功能的影响

目的探讨右室电极植入对心脏结构和功能的影响。方法前瞻性入选2017年2月至2018年4月在阜外医院心律失常中心首次植入永久起搏器(PPM)/埋藏式心脏转复除颤器(ICD)治疗72例患者,结合二维+三维心脏超声检查方法,对心脏起搏器植入患者术前、术后1周以及术后1年进行超声评价,比较患者术前术后的超声数据的差异。结果入组72例患者均完成术后1年随访。术后1周复查心脏超声:新发三尖瓣返流(TR)2例,TR程度加重5例,术后1周导线相关三尖瓣返流(LRTR)的发生率为9.7%;术后1年,新发TR 2例,TR程度加重14例,术后1年LRTR的发生率为22.2%。与术前心脏结构和功能比较,电极导线植入术后1周,左右心脏结构和功能无明显变化;植入术后1年,三尖瓣返流(TR)程度为中重度返流的比例明显升高(16.7%vs 5.6%),伴右房、右室直径增大[右房直径:(37.66±5.52) mm vs (35.93±4.85) mm;右室直径:(24.49±3.87) mm vs (22.61±2.61) mm]以及右室射血分数降低[(0.46±0.06) vs (0.48±0.05),P均0.05],而左心结构和功能无明显变化。与瓣叶非受限组患者比较,瓣叶受限组患者TR程度为中重度返流的比例明显升高(41.7%vs 12.1%),伴右房、右室直径增大[右房直径:(42.15±7.95) mm vs (36.76±4.47) mm;右室直径:(27.75±3.65) mm vs (23.84±3.60) mm]以及右室射血分数降低[(0.42±0.06) vs (0.47±0.06),P均0.05]。结论心脏起搏治疗中LRTR的发生率较高;电极导线植入将加重TR程度,导致右房、右室增大以及右室射血分数降低;电极导线引起三尖瓣瓣叶受限与右心结构和功能的改变相关。     

自体心包三尖瓣成形与人工瓣环三尖瓣成形的中远期疗效比较

目的 比较自体心包条三尖瓣成形与人工瓣环三尖瓣成形治疗功能性三尖瓣反流的中远期疗效.方法 将2000-2010年间收治的76例功能性三尖瓣反流患者随机分为两组：A组（46例）以人工瓣环行三尖瓣成形,B组（30例）以自体心包条环缩三尖瓣环行三尖瓣成形.分别于术后3年、5年、8年对两组患者右心房内径、右心室内径和三尖瓣反流程度进行对比观察.结果 术后心功能分级较术前提高1～2级,两组患者右心房内径、右心室内径和三尖瓣反流面积比较差异无统计学意义（P＞0.05）.结论 自体心包三尖瓣环成形术是治疗功能性三尖瓣反流的有效方法,其中远期疗效与人工瓣环三尖瓣成形术相似,但治疗费用明显降低.     

非瓣膜性心房颤动合并重度三尖瓣反流的危险因素分析

目的:探讨非瓣膜性心房颤动(NVAF)合并重度三尖瓣反流(TR)患者的临床特征及危险因素.方法:连续入选2016年1月至2019年12月就诊于我院的290例合并TR的NVAF患者,87例NVAF合并重度TR患者为重度TR组,男性35例,平均年龄(73.5±9.0)岁;203例NVAF合并轻-中度TR患者作为对照组,男性...     

应用自体心包片延伸三尖瓣前叶结合人工瓣环成形术治疗重度三尖瓣关闭不全

目的:探索应用自体心包片延伸三尖瓣前叶治疗重度三尖瓣关闭不全的手术方法,并评价其临床效果。方法:自2009年1月至2012年5月,对31例重度三尖瓣关闭不全患者,采用自体心包片延伸三尖瓣前叶手术结合人工瓣环成形术进行治疗。并通过术前、术后心脏超声测量Tei指数及右心房变化,反映三尖瓣手术结果,评价手术效果。结果:手术患者均顺利出院,无手术死亡,患者手术后心脏超声提示三尖瓣轻度关闭不全4例,微量反流5例,无反流22例,均顺利出院。随访4～40个月,31例患者心功能恢复良好,Ⅰ～Ⅱ级,Tei指数明显下降,右心功能改善。三尖瓣关闭不全除1例有早期的轻度关闭不全变成轻-中度关闭不全外,其余没有变化。结论:自体心包片延伸三尖瓣前叶结合人工瓣环成形术,是一种治疗重度三尖瓣关闭不全的较为理想的手术方式,在短期内基本消除了残余反流/复发反流。长期随访将证明其消除残余反流/复发反流的疗效。     

成形软环应用于三尖瓣关闭不全修复的疗效评价

目的:了解国产三尖瓣成形软环对继发于左心系统瓣膜病变造成的三尖瓣关闭不全的治疗效果. 方法:自2002-08至2004-08,我院收治的63例继发性三尖瓣关闭不全病人,在行左心系统瓣膜病变矫治时,应用国产三尖瓣成形软环同期行三尖瓣成形术.49例病人获得随诊,平均随诊时间为17.4±10.3(3～33)个月. 结果:63例病人在术后早期均治愈出院.49例病人随诊时有l例病人死于非三尖瓣成形所致原因;其余48例随诊病人较术前症状均有改善,心功能较术前提高,超声检查示三尖瓣中量反流3例,大量反流1例. 结论:国产三尖瓣成形软环对三尖瓣关闭不全有明显的治疗效果.成形效果优劣的关键在于术中对三尖瓣瓣环的有效处理.三尖瓣瓣环越大,则更应选择相对较小的人工瓣环,成形时不仅要缩小三尖瓣的游离缘瓣环,还要将部分三尖瓣隔瓣瓣环予以缩小和固定.     

Compassionate Use of the PASCAL Transcatheter Valve Repair System for Severe Tricuspid Regurgitation: A Multicenter,Observational, First-in-Human Experience

ObjectivesThe purpose of this observational first-in-human experience was to investigate the feasibility and safety of the PASCAL transcatheter valve repair system and its impact on short-term clinical outcomes in patients with severe tricuspid regurgitation (TR).BackgroundTranscatheter repair of severe TR is a promising treatment option for patients at prohibitive surgical risk. Large leaflet coaptation gaps and tethering represent common features that challenge the application of transcatheter repair techniques.MethodsTwenty-eight patients with severe TR were treated with the PASCAL system in a compassionate use experience at 6 sites. All patients had heart failure due to severe TR and were deemed at high surgical risk by institutional heart teams. The primary outcome was procedural success, defined as the implantation of at least 1 device with post-procedural TR grade ≤2+, without mortality or conversion to surgery.ResultsAll patients (mean age 78 ± 6 years, 54% women) were at high surgical risk (mean European System for Cardiac Operative Risk Evaluation II score 6.2 ± 5.2%). TR etiology was functional in 92%, with mean tricuspid annular diameter of 49.5 ± 6 mm and mean coaptation gap of 6.9 ± 3 mm. Procedural success was 86%, with 1.4 ± 0.6 devices implanted per patient. There were no intraprocedural complications. At 30-day follow-up, mortality was 7.1%, 88% of patients were in New York Heart Association functional class I or II, with TR grade ≤2+ in 85%. There were 2 single-leaflet device attachments, which were managed conservatively. Six-min walk distance improved from 240 m (interquartile range: 172 to 337 m) to 335 m (interquartile range: 251 to 385 m) (p < 0.001).ConclusionsThis first-in-human experience evaluating transcatheter tricuspid repair with the PASCAL system demonstrated high procedural success, acceptable safety, and significant clinical improvement. Larger prospective studies with long-term follow-up are needed to confirm these initial promising results and further define the impact of PASCAL tricuspid repair on clinical outcomes.     

Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy

OBJECTIVES: Because pulmonary thromboendarterectomy (PTE) can result in an immediate reduction in pulmonary artery (PA) pressure, we sought to evaluate the effect of PTE on severe tricuspid regurgitation (TR) without tricuspid annuloplasty. BACKGROUND: Few data exist regarding the frequency and magnitude of functional TR improvement after reduction in PA pressure. METHODS: We identified 27 patients with severe TR, defined by a regurgitant index (RI) >33%, who underwent PTE. The RI, tricuspid annular diameter (TAD), apical displacement of leaflet coaptation, and estimated PA systolic pressure were determined on pre- and post-PTE echocardiograms. Patients were stratified based on resolution (RI < or =33%) or persistence (RI >33%) of severe TR. RESULTS: Comparing pre- and post-PTE echocardiography results, severe TR resolved in 19 of 27 (70%) patients. This group had a more effective PA systolic pressure reduction after PTE (49 +/- 20 mm Hg vs. 32 +/- 16 mm Hg by echocardiography, p = 0.075, and 37 +/- 16 mm Hg vs. 16 +/- 13 mm Hg by catheter measurement, p = 0.004). No difference was observed in TAD, apical displacement of the tricuspid valve, or other features compared with the group with persistent severe TR. There was a trend toward longer hospital stays in the group with persistent severe TR (19 +/- 15 days vs. 14 +/- 9 days; p = 0.55). CONCLUSIONS: After significant PA pressure reduction by PTE, severe functional TR with a dilated annulus may improve without annuloplasty despite dilated tricuspid annulus diameters.     

De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation

BACKGROUND AND AIM OF THE STUDY: Residual or recurrent tricuspid regurgitation (TR) has been reported after several types of surgical repair. The development of late TR is an important complication of left heart surgery. The results of De Vega annuloplasty were compared with those obtained after Carpentier-Edwards ring (CE ring) annuloplasty in patients with secondary TR. METHODS: The records of 45 patients who underwent surgery for secondary TR between January 1995 and July 2000 were reviewed retrospectively. Twenty-eight patients underwent De Vega annuloplasty, and 17 had a CE ring annuloplasty. The groups were similar with respect to associated cardiac lesions. No significant preoperative differences were observed in NYHA functional class, TR grade, and pulmonary artery pressure between the two groups. RESULTS: One CE patient died of left ventricular dysfunction after postoperative bleeding. The 28 De Vega patients and remaining 16 CE patients had an uneventful recovery, and were discharged. Tricuspid ring size after repair was similar between groups. Mean (+/- SD) follow up in the entire patient cohort was 39+/-23 months (range: 6 to 75 months). TR recurrence was rated as grade II or III in 13 patients (45%) after De Vega annuloplasty, but was grade II or III in only one patient (6%) patient after CE ring annuloplasty. There was a significant difference in TR recurrence between the groups (p = 0.027), but no significant difference in NYHA class. CONCLUSION: CE ring annuloplasty significantly decreased the recurrence of TR; thus, CE ring annuloplasty is superior to De Vega annuloplasty in patients with secondary TR.     

膜周部室间隔缺损合并三尖瓣中、重度反流行介入治疗的疗效分析

目的:探讨膜周部室间隔缺损(VSD)合并三尖瓣中、重度反流行介入治疗的可行性,并评价其疗效.方法:分析2016-01至2017-12我院膜周部VSD合并三尖瓣中、重度反流44例患者,通过应用超声心动图,观察VSD形态、三尖瓣反流程度及原因,评估VSD介入治疗效果及三尖瓣反流在介入术前、术后的变化.结果:43例患者介入治...     

Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement

BACKGROUND: The development of late tricuspid regurgitation (TR) following left cardiac valve replacement is an important complication, as it is associated with a severe impairment of exercise capacity and a poor symptomatic outcome. The pathogenesis of this condition remains poorly defined. It is still a challenge in terms of its prevention, treatment and indications for surgical correction. AIMS: To investigate the possible pathogenesis and report the surgical results of the late TR after left cardiac valve replacement. METHODS: There were 56 patients with moderate to severe TR after left cardiac valve replacement, divided into normal prosthesis group (10 patients with normal prosthetic valve function) and dysfunctional prosthesis group (46 patients with prosthetic valve dysfunction). In the normal prosthesis group, 4 patients underwent mitral valve replacement (MVR) and 6 patients underwent combined mitral and aortic valve replacement (DVR). Patients in the dysfunctional prosthesis group included MVR in 36, aortic valve replacement (AVR) in 4 and DVR in 6, with bioprosthetic valve dysfunction occurring in 18, mechanical prosthetic valve obstruction in 22 and periprosthetic valve leakage in 6 patients. At the initial operation, 10 patients underwent DeVega's tricuspid annuloplasty and 46 patients' tricuspid valves were normal. At the second operation, the surgical treatment of TR included tricuspid valve replacement (TVR) in 9 and tricuspid annuloplasty in 47. RESULTS: Two patients died postoperatively giving a 3.6% hospital mortality. The 54 survivors were followed up for 6-132 months (mean of 79.4 months). Heart function improved significantly in 8 with TVR and in 40 with tricuspid annuloplasty. Echocardiography showed moderate TR in 5 and severe TR in 1 patient with tricuspid annuloplasty who need a further surgical treatment. CONCLUSION: Pulmonary hypertension, myocardial dysfunction, and atrial fibrillation might be responsible for the development of late TR after left cardiac valve replacement. Tricuspid annuloplasty, as the surgical method of first choice, resulted in improvement in 87% of patients with late TR after left cardiac valve replacement. TVR can also be safely applied to repair organic disease and the extremely dilated tricuspid valve annulus. If the TR area is more than 25cm(2), the TVR is recommended.     

外科生物瓣毁损患者使用Venus-A人工瓣膜行经导管主动脉瓣置换术术前CT评估的方法与效果

目的 探讨术前计算机断层扫描(CT)评估外科主动脉生物瓣环内径中多平面曲线瓣环测量法及三维重建法测量间的差异以及基于CT结果指导外科生物瓣毁损患者使用Venus-A瓣膜行经导管主动脉瓣置换术(TAVR)的有效性及安全性.方法 回顾性分析2013年3月至2019年10月连续10例在外科毁损生物瓣中采用Venus-A瓣膜行...     

Tangled wire in a Dacron band during Cardioband transcatheter tricuspid annuloplasty—How to solve the problem

Transcatheter tricuspid valve intervention (TTVI) is an emerging treatment for patients with symptomatic severe tricuspid regurgitation (TR). Currently, the issues that arise during TTVI are unclear. Here, a 78-year-old woman with severe TR underwent transcatheter tricuspid valve annuloplasty using a Cardioband (Edwards Lifesciences, Irvine, CA). We attempted to cinch the Dacron band after anchoring; however, it was impossible to connect the distal tip of the size adjustment tool and the Dacron band because the cinching wire was tangled around the Dacron band. We resolved this issue without surgical intervention, and eventually cinched the annulus. Final echocardiography revealed dramatic TR reduction. To our knowledge, no study has reported a tangled wire in a Dacron band during Cardioband use. Clinicians should be aware of the risks accompanying this concern in case where it is impossible to connect the distal tip of the size adjustment tool and the Dacron band during cinching.