风湿性心脏病二尖瓣置换术后三尖瓣返流的再手术治疗

目的分析风湿性心脏病二尖瓣置换术后再发三尖瓣返流（TR）患者的临床特点、外科手术方法和疗效，总结围手术期处理经验。方法2000年1月至2011年12月，17例风湿性心脏病二尖瓣置换术后再发三尖瓣返流的患者在我院接受单纯再次三尖瓣手术，行三尖瓣成形术10例，包括单纯DeVega成形术1例、瓣叶成形＋人工瓣环成形9例；行三尖瓣置换术7例，其中置换生物瓣4例，双叶机械瓣3例，回顾性分析其临床表现、诊治经过和预后情况。结果术后早期死亡1例（5．88％，1／17），死于术后左心功能衰竭。术后发生低心排血量综合征3例，肾功能不全2例，呼吸功能不全2例，均成功救治。随访14例，随访时间3～9年，心功能I级2例，Ⅱ级8例，Ⅲ级4例。失访2例。结论对风湿性心脏病二尖瓣置换术后三尖瓣返流患者再手术治疗效果较好，合理掌握手术指征、手术时机和良好的围手术期处理是提高手术成功率的关键。

Re-operatlon of tricuspid regurgitation after mitral valve replacement with rheumatic heart disease

Objective To analyze clinical manifestation and investigate therapy effect of re-operation of tricuspid regurgitation （TR） after mitral valve replacement with rheumatic heart disease. Methods Seventeen cases with rheumatic heart disease recurred TR after mitral valve replacement surgery,underwent tricuspid valve surgery again in the Third People＇s Hospital of Nanchaag from January 2000 to December 2011. Of 17 cases, 10 cases underwent tricuspid valve annuloplasty including 1 case for pure De Vega plasty, 9 cases for the valve leaflets forming ＋ artificial valve ring forming. Another 7 cases underwent tricuspid valve replacement surgery including 4 cases for biological valve replacement and 3 cases for mechanical valve. Retrospective analyzed the clinical manifestations, treatment process and condition of prognosis. Results One case was with early postoperative deaths （5.88%, 1717 ）, and died of postoperative left ventricular failure. Three cases were postoperative low cardiac output syndrome, 2 cases were renal insufficiency, and 2 cases were respiratory insufficiency,all those cases were successfully cured. Sixteen cases were followed up from 3 months to 9 years and 2 cases were lost. Of 14,2 cases were NYHA class 1,8 cases for grade II ,4 cases for gradem. Conclusion After mitral valve replacement in patients with rheumatic heart disease, TR in patients with reoperation is a suitable choice. Reasonable surgical indications, timing of surgery and good perioperative management are the keys to improve the success rate of surgery.