三尖瓣置换术后早期及晚期疗效

目的　总结三尖瓣置换术后早期及晚期疗效 ,并分析与早期病死率可能有关的危险因素。方法　行三尖瓣置换术 2 3例病人中男 11例 ,女 12例 ;年龄 12～ 5 6岁 ,平均 2 7岁。其中三尖瓣下移畸形17例、先天性三尖瓣发育不全 3例、风湿性病变 2例、感染性心内膜炎 1例。术前心功能II级 3例、III级13例 ,IV级 7例。结果　本组死亡 3例 ,早期病死率 13%。平均随访时间 80个月 (5～ 130个月 ) ,随访率95 %。晚期死亡 1例 (5 2 % )。1例于术后 86个月时因生物瓣失功再次行三尖瓣置换 ;1例右房血栓。术后生存者心功能I～II级 15例 ,III级 3例。多因素分析显示 ,心功能IV级 (P =0 0 2 )、严重腹水 (P =0 0 0 1)及置换机械瓣 (P =0 0 13)与术后早期病死率有显著相关。结论　三尖瓣置换术后早期及晚期效果良好。术前心功能IV级、严重腹水以及置换机械瓣对术后早期病死率有明显影响

Early and late results of tricuspid valve replacement

Objective To evaluate the early and late results after tricuspid valve replacement. Methods From August 1988 to January 1999, 23 patients were underwent tricuspid valve replacement in our hospital. There are 11 males and 12 females with a mean age of 27 years(range, 12 to 56 years). The tricuspid lesions included Ebstein's anomaly in 17 cases, dysplasia of the tricuspid valve in 3, rheumatic valvular disease in 2 and infective endocarditis in 1. The preoperatively heart functional class (NYHA) was II in 3, III in 13 and IV in 7 patients. Results Three patients died postoperatively with an operative mortality of 13%. Mean follow up period was 80 months (range 5 130 months). There was 1 late death due to right ventricular failure. One patient was re operated for failure of bioprosthesis at 7 years and 2 months after initial surgery. Right atrial thrombus occurred in 1 patient. Late functional class was I or II in 15 and III in 3 patients. Multiple regression analysis showed that the preoperative heart functional class(P=0 02), severe ascites(P=0 001) and mechanical valve replacement(P=0 013) were risk factors for hospital mortality. Conclusion The present study indicates that the early and late results are satisfactory, and heart functional class, severe ascites and mechanical valve replacement are risk factors for hospital mortality.