人工血管环代成形环治疗三尖瓣关闭不全56例

目的探讨以人工血管环代替成形环治疗三尖瓣关闭不全的临床效果。方法回顾性分析第二军医大学长海医院2000年7月至2010年7月收治三尖瓣关闭不全56例患者的临床资料,其中男24例,女32例;年龄14～73(45.7±21.8)岁;均经心脏彩色多普勒超声心动图明确诊断为三尖瓣中度至大量反流(瞬时反流量>6 ml),其中风湿性心脏瓣膜病47例,先天性心脏病三尖瓣下移畸形9例。均采用人工血管环代替成形环治疗三尖瓣关闭不全。结果全组患者无早期死亡。术后1个月心脏超声心动图提示无三尖瓣关闭不全或轻度关闭不全,发生并发症3例,其中术后呼吸功能衰竭1例,肾功能不全1例,开胸止血1例。远期随访48例,平均随访3.8(1.0～9.5)年,无晚期死亡,发生抗凝并发症(脑梗死)1例;心功能分级(NYHA):Ⅰ级16例,Ⅱ级26例,Ⅲ级6例。随访期间超声心动图检查提示:三尖瓣无关闭不全36例,轻度关闭不全10例,中度关闭不全2例,无严重并发症。结论人工血管环代替成形环治疗三尖瓣关闭不全可以取得较满意的早期和中期的临床疗效,可作为治疗三尖瓣关闭不全的手术方法之一。

Ring Annuloplasty Using Prosthetic Vascular Graft for the Treatment of Tricuspid Regurgitation:Experience in 56 Patients

Objective To evaluate the surgical effect of ring annuloplasty using prosthetic vascular graft for the treatment of tricuspid regurgitation.Methods From July 2000 to July 2010,ring annuloplasty using prosthetic vascular graft was performed to a total of 56 patients with tricuspid regurgitation in Changhai Hospital of Second Military Medical University.There were 24 male patients and 32 female patients.Their mean age was(45.7±21.8) years(ranging from 14 to 73 years).All the patients were diagnosed as moderate to severe tricuspid regurgitation by color Doppler echocardiography examination,including 47 patients with rheumatic heart valve diseases,and 9 patients with congenital heart disease(Ebstein’s anomaly).All the 56 patients underwent ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation.Results There was no in-hospital death.Postoperatively,one patient had acute respiratory failure,one patient had acute kidney failure,and one patient had re-exploration for bleeding.All patients had none or mild tricuspid regurgitation by echocardiography examination one month after surgery.Forty eight patients were followed up from 1.0 to 9.5 years with a median follow-up time of 3.8 years.During follow-up,there was no late death,but one patient had brain embolism as an anticoagulation complication.Sixteen patients were in New York Heart Association(NYHA) functional classⅠ,26 patients in NYHA classⅡ,and 6 patients in NYHA classⅢ. Thirty six patients had no tricuspid regurgitation,10 patients had mild tricuspid regurgitation,and 2 patients had moderate tricuspid regurgitation by echocardiography examination during follow-up. Conclusion The early and mid-term follow-up results of ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation are satisfactory.It is a good choice for the surgical treatment of tricuspid regurgitation.