超声心动图评价三尖瓣硬质三维环成形术对继发性三尖瓣关闭不全的疗效

摘要

Objective To evaluate the outcomes of rigid 3D ring annuloplasty for functional tricuspid regurgitation by echocardiography. Methods 35 patients with functional tricuspid regurgitation undergoing rigid 3D ring annuloplasty and left-side valve operation were observed as TVP+ group, and 15 patients with functional tricuspid regurgitation undergoing left-side valve operation but not received tricuspid annuloplasty were observed as TVR- group. The degree of TR,TVAD, RAD, RVD,VE and RVEF were measured by Echocardiography preoperatively and postopera-tively. Results The degree of TR, TV AD, RAD, RVD were decreased significantly after operation in TVR+ group (P<0. 05). There were no much changes of TR, TVAD, VE ,RVEF one year later after operation(P>0. 05). RAD and RVD were reduced further(P<0. 05). Conversely there were no much changes of the degree of TR, TVAD, RAD, RVD, VE and RVEF after two weeks of operation in TVR- group(P>0. 05). However, the degree of TR, TVAD, RAD, RVD were enlarged and RVEF was reduced significantly after one year of operation in TVR- group (P<0. 05 ). Conclusions Tricuspid annuloplasty should be preformed simultaneously with left-side valve operation for patients with functional tricuspid regurgitation. Rigid 3D ring annuloplasty for functional tricuspid regurgitation is helpful to improve the right heart structure and function. The outcome is stable after operation.%目的 通过超声心动图评价继发性三尖瓣关闭不全患者行三尖瓣硬质三维环成形术的意义及疗效.方法 左心瓣膜手术同期行三尖瓣硬质三维环成形术的患者(TVP阳性组)35例与未能同期行三尖瓣成形术者(TVP阴性组)15例,分别于术前、术后2周、术后1年通过超声心动图测量三尖瓣环直径(TVAD),舒张期三尖瓣口E峰值流速(ⅤE),三尖瓣反流束面积(TRA),三尖瓣反流分数(TRF),右房内径(RAD),右室内径(RVD)及右室射血分数(RVEF),重点比较术后与术前、术后1年与术后2周时各参数的变化.结果 TVP阳性组:术后2周及术后1年TVAD、TRA、TRF、RAD及RVD均显著减低(P＜0.05)；ⅤE及RVEF无显著变化(P＞0.05)；术后1年与术后2周相比,TVAD、TRA、TRF无明显变化(P＞0.05),而RAD及RVD进一步缩小(P＜0.05).TVP阴性组:术后2周TVAD、TRA、TRF、RAD、RVD、ⅤE及RVEF均无显著变化(P＞0.05)；术后1年与术后2周相比,TVAD、TRA、TRF、RAD及RVD均显著增加,RVEF则减低(P＜0.05).结论 继发性中度以上三尖瓣关闭不全的患者应于左心瓣膜手术同期尽早行三尖瓣成形术,三尖瓣硬质三维环成形术有助于患者右心结构和功能的改善,且术后疗效稳定.