2019 年第 2 期 第 14 卷

三尖瓣机械瓣置换术临床分析

Clinical analysis of tricuspid valve mechanical prosthesis replacement

作者：孙广龙李继勇曹向戎梁林陈辛亮伯平

英文作者：

单位：100029首都医科大学附属北京安贞医院心外科十病房

英文单位：

关键词：心瓣膜疾病；三尖瓣置换；机械瓣；术后并发症；瓣周漏；再手术；心律失常

英文关键词：

• 摘要：

• 【摘要】目的    研究三尖瓣机械瓣置换患者的疗效和术后生存情况，以利提高三尖瓣疾病的手术疗效。方法    回顾性分析2010年1月至2017年12月因三尖瓣病变或合并其他瓣膜病变在首都医科大学附属北京安贞医院行三尖瓣机械瓣置换的36例患者的临床资料，其中男22例、女14例，年龄28～64岁、平均（52±9）岁，纽约心脏病协会心功能Ⅱ级22例、Ⅲ级12例、Ⅳ级2例。所有患者术前超声心动图结合术中探查明确三尖瓣病变，其中后天性风湿性心脏病28例，三尖瓣发育不全4例，先天性心脏病Ebstein畸形3例，法洛四联症术后1例。所有患者均行三尖瓣机械瓣置换术或多瓣膜联合置换手术，共用机械瓣膜45枚。结果    36例患者中住院死亡3例(8.3%)，主要死因为右心功能不全、感染及多脏器功能衰竭。1例患者于术后97 d出院，其余32例患者术后住院时间8～21 d。本组研究对象共随访33例，随访率91.7%（33/36），随访时间3～42个月。1例患者术后3个月发生三尖瓣瓣周漏，再次入院行三尖瓣生物瓣置换；其余所有随访者未发生死亡以及瓣膜相关心血管事件。结论    三尖瓣置换手术风险大，需严格把握适应证。对于无法行三尖瓣修复或修复失败的患者，可考虑行三尖瓣置换术，三尖瓣机械瓣置换手术效果理想。

• 【Abstract】Objective    To observe the surgical outcome and survival of patients with tricuspid valve mechanical prosthesis replacement. Methods    Clinical data of 36 patients receiving tricuspid mechanical valve replacement in Beijing Anzhen Hospital, Capital Medical University between January 2010 and December 2017 was retrospectively reviewed. There were 14 females and 22 males, with a mean age of （52±9）years (28-64 years old). Among the patients, 22 cases were in New York Heart Association(NYHA) functional class Ⅱ, 12 cases were in NYHA class Ⅲ and 2 cases were in NYHA class Ⅳ. Tricuspid valvular lesion of all patients was confirmed by echocardiography and surgical findings. There were 28 cases of rheumatic heart disease, 4 cases of tricuspid valvular hypoplasia, 3 cases of congenital heart disease(Ebstein′s anomaly) and 1 case of tetralogy of Fallot. Mechanical valve replacement of tricuspid valve or multi-valve replacement was implemented and 45 mechanical prostheses were used. Results    Three patients died of right heart insufficiency, infection and multiple organ dysfunction, the postoperative in-hospital mortality was 8.3%(3/36). One patient was discharged 97 days after surgery; 32 patients were discharged in 8-21 days after surgery. The mean follow-up interval was 3-42 months in 33 patients(91.7%). During follow-up, 1 patient developed paravalvular leakage 3 months after surgery and underwent reoperation of bioprosthetic valve replacement; other patients survived without any valve-related events. Conclusions    Tricuspid valve replacement has high risks of mortality and morbidity and requires rigorous indications. Patients with no indication of tricuspid valve repair or failure in repair can have valve replacement and the surgical effect is valid.