三尖瓣成形术后复发性关闭不全的外科治疗

目的 探讨在左心瓣膜替换同期三尖瓣成形术（TVP）后再次发生三尖瓣关闭不全（TR）的可能机制和手术结果。方法 二尖瓣位再次行二尖瓣置换（机械瓣）28例（附加主动脉瓣置换3例）。三尖瓣的处理：三尖瓣置换（TVR，牛物瓣）11例，余均再次行改良的DeVega成形术。结果 早期死亡3例。随访22例中，11例TVR者全部存活，心功能改善；第2次行TVP者中6例为极轻度或轻度TR，2例为中度TR，3例为中度以上TR，其中1例于术后6个月死于多器官功能障碍综合征。结论 TR的发生可能与持续肺动脉高压引起右心及瓣环功能不可逆损害、反复的风湿发作、术前并发心源性恶液质等有关。重度TR及三尖瓣风湿性改变者行TVR的效果良好，中度TR者仍可再次行TVP且疗效满意。

SURGICAL TREATMENT OF RECURRENT INCOMPETENCE AFTER TRICUSPID VALVULOPLASTY

Objective To investigate the possible pathogenesis of recurrent incompetence(TI) after tricuspid valvuloplasty(TVP). Methods Recurrent TI after TVP was performed in 28 patients.Prior left heart valve replacement(MVR or DVR) was performed with mechanical valve in 11 cases(group A) and biological valve in 17(group B).The surgery included MVR in 28 and TVR in 11 and TVP in 17 at the second operation.Two different methods of TVP were used for correction of TI. Results(Three patients) died postoperatively.Follow-up of the 22 survivors showed that the heart function improved significantly in 11 after TVR and six after TVP. Conclusion The irreversible right heart impairment,sustained pulmonary hypertension,syndrome of cardiac cachexia(SOCC),rheumatic tricuspid valve lesion may be responsible for the development of late recurrent TI after TVP.At the second operation,TVR may achieve excellent result for severe functional TI and rheumatic tricuspid valve lesion.