摘要
目的观察二尖瓣置换(MVR)加或不加三尖瓣成形术前后右房室径及房室环的变化情况。方法纳入112例2005年4月至2006年12月施行MVR术的患者进入本研究。根据术前超声心动图检查,按照最大三尖瓣环径/体表面积≥21mm/m2的标准,112例患者被分为三尖瓣成形组(TAPG,n=56)和非三尖瓣成形组(NTAPG,n=56)。TAPG在术中加做三尖瓣成形术。术后定期随访,两年复查超声心动图。结果112例患者平均随访时间(25.04±5.04)月。两组患者年龄、性别构成、体表面积、心功能之间的差异无统计学意义(P>0.05),但TAPG中伴有房颤的患者多于NTAPG(P<0.05)。TAPG患者术后右房室径、最大及最小三尖瓣环径均缩小(P<0.05),三尖瓣环缩短分数变化不明显(P>0.05),三尖瓣返流(TR)程度构成比减轻(P<0.05)。而NTAPG患者术后右房室径变化不明显(P>0.05),最大及最小三尖瓣环径增加(P<0.05),三尖瓣环缩短分数变化亦不明显(P>0.05),TR程度构成比无明显变化(P>0.05),但术后出现5例(8.94%)中度及中度以上TR。结论在术前右房室径及三尖瓣环径明显扩张的患者,MVR术中加做三尖瓣成形,将有利术后右房室径及三尖瓣环的明显缩小、TR程度构成比的显著改善。对于术前没有明显右房室径及三尖瓣环扩张的MVR手术患者也应仔细评估三尖瓣情况,因为随着时间的推移,这些患者可能出现明显的TR。
Objective To observe changes of right atrioventricular diameter and annulus after mitral valve replacement （MVR） in patients with and without tricuspid annuloplasty. Methods A total of 112 patients who underwent MVR surgery from April 2005 to December 2006 were recruited in this study. The patients were divided into two groups. Those with maximal tricuspid annulus diameter/body surface area ≥ 21 mm/m^2 were given tricuspid annuloplasty （TAPG, n=56）. Otherwise, no tricuspid annuloplasty were performed （NTAPG, n=56）. All of the patients were followed up regularly. The echocardiography were reviewed two years after the surgery. Results An average of （25. 04 ± 5. 04） months had passed when the echocardiography were reviewed. The two groups had no differences in age, gender, body surface areas and cardiac functions （P〉 0.05）. The TVPG group had more patients with atrial fibrillation than the NTVPG group （P〈0.05）. In the patients in the TVPG group, the right atrioventricular diameter, and maximal and minimal tricuspid annulus diameter were significantly narrowed after the operations （P〈0.05）. The percent shorting of tricuspid valve annulus did not change significantly （P〉 0.05）. The constituent ratio of TR was significantly reduced （P〈0.05）. However, in the patients in the NTVPG group, the right atrioventricular diameter did not change significantly （P〉 0. 05）. The maximal and minimal tricuspid annulus diameter increased （P〈0. 05）. The percent shorting of tricuspid valve annulus did not change significantly （P〉0.05）. Though the constituent ratio of TR had no significant changes, 5 （13. 5%） patients developed moderate or serious TR two years after the operations. Conclusion Tricuspid annuloplasty （TAP） has benefits for the patients with enlarged right atrioventricular and tricuspid annulus. For those patients without enlarged right atrioventricular and tricuspid, their tricuspid valve conditions should also be carefully assessed. Because as time lapse, these patients may also develop TR.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2009年第3期490-494,共5页
Journal of Sichuan University(Medical Sciences)
基金
成都市科技攻关计划(07GGYB150SF)资助
关键词
二尖瓣置换
三尖瓣成形
右房室径
右房室环
三尖瓣返流
Mitral valve replacement Tricuspid annuloplasty Right atrial and ventricular diameter Right atrioventricular annulus Tricuspid regurgitation
