左心瓣膜置换术后远期三尖瓣关闭不全的外科治疗

目的:评价左心瓣膜置换术后三尖瓣重度关闭不全外科治疗效果。方法:对25例左心瓣膜置换术后,人工瓣膜功能正常,三尖瓣重度关闭不全患者行三尖瓣成形术或三尖瓣置换术;首次手术二尖瓣置换术17例,二尖瓣加主动脉瓣置换术8例,在首次手术中10例曾行三尖瓣DeVega法成形术。结果:三尖瓣成形术13例;三尖瓣置换术12例。术后早期死亡4例,病死率16%。随访7个月～8年,平均(5.1±2.6)年,2例三尖瓣置换患者死于心血管事件,长期生存15例,心功能Ⅱ级8例,Ⅲ级4例,Ⅳ级3例,多数仍需强心、利尿药维持,临床症状明显改善。结论:对左心瓣膜置换术后三尖瓣重度关闭不全患者外科手术是一种合适的选择。合理掌握手术指征、手术时机和良好的围手术期治疗是手术成功的关键。

Effect of surgical treatment of tricuspid regurgitation late after valve replacement of left heart

Objective：To investigate the outcome of surgical treatment of tricuspid regurgitation late after valve replacement of left heart.Methods：Twenty five patients with tricuspid insufficiency,with the diagnosis conformed by echocardiogram,were treated surgically after left heart valve replacement from march 2000 to december 2008,including 17 mitral valve replacements and 8 double valve replacements.DeVega was used in 10 patients.Results：Tricuspid repair was performed in 13 patients,tricuspid replacement was done in 12 patients.The mechanical valves were implanted in all patients.There was four death early after operation.The hospital mortality was 16%.The low cardiac output and multiple organ failure were the causes of death.The patients were followed up for 5.1 years（7 months-8 years）.Two patients died from the heart disease.Among the survivors,all patients showed improvement of symptoms,while most patients needed medical therapy（The heart functions were upgraded to grade I-Ⅱ）.Conclusion：The irreversible right heart impairment and severe pulmonary hypertension and/or unsatisfaction of tricuspid repair in the first operation are responsible for the development of late functional tricuspid regurgitation after left cardiac valvular replacement.The surgical intervention should be earlier before the onset of severe right ventricular failure.Surgical operation is effective on late tricuspid regurgitation after left cardiac valvular replacement due to rheumatic heart disease.