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功能性三尖瓣关闭不全的分析和治疗 |
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解基严 王京生 刘传绶 王新生 陈生龙 漆一伟
【摘要】 目的 为提高治疗功能性三尖瓣关闭不全(TR)水平，总结近5年临床体会。方法 分析35例经手术治疗TR患者，其中瓣膜病组26例，先心病组9例。瓣膜病组与同期79例患者资料比较，手术行三尖瓣环成形术。结果 瓣膜病组TR发生率为55.2%，其与病程、心胸比值、EF、左房大小有关(P<0.05)，其中82.8%为心房颤动(P均<0.01)，重度肺高压67.2%(P<0.05)。先心病组中左向右分流患者均为重度肺动脉高压，有紫绀患者均有右心扩大。随访24例，心功能Ⅰ级17例、Ⅱ级6例、Ⅲ级1例。结论 三尖瓣环成形术是治疗TR有效方法，应根据临床表现、右心功能、肺血管阻力及TR程度决定手术指征。
【关键词】 心脏瓣膜疾病 心脏外科手术
Clinical analysis and treatment for “functional” tricuspid valve regurgitation Xie Jiyan, Wang Jingsheng, Liu Chuanshou, et al. Department of Cardiac Surgery, People s Hospital, Beijing Medical University, Beijing 100044
【Abstract】 Objective Our five-year experience in surgical treatment of “functional” tricuspid valve regurgitation (TR) was summarized for the purpose of improving the treatment.Methods Thirty five patients were analyzed. There were 26 patients in the valve group and nine in the congenital heart disease (CHD) group. Cohn′s annuloplasty was performed in all patients. Patients in the valve group were compared with 79 patients who received valve replacement in the same period.Results The incidence of TR was 55.2% (58/105) in the valve group. TR was associated with the course of the disease, C/T, EF and LA size (P<0.05). In the TR group 82.5% patients showed atrial fibrillation rhythm (P<0.01) and 67.2% pulmonary hypertension (P<0.05). In the patients with noncyanotic CHD, the pulmonary resistance was 125-230 kPa*S-1*L-1. In four cyanotic patients the right atrium or ventricle was markedly dilated. Twenty four patients were followed for 2-66 months (mean of 25.4 months). Five patients had mild TR(20.8%). Among the 24 patients, cardiac function was classified as NYHA Ⅰ, Ⅱ and Ⅲ in 17, 6 and 1 patients, respectively. Conclusion Cohn′s operation is effective for the treatment of TR. It should be emphasized that the therapeutic &127;strategy should be based on clinical status, right heart function, pulm[1] [2] [3] 下一页
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