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左心瓣膜手术后重度三尖瓣反流的外科治疗 被引量：1

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摘要 目的总结左心瓣膜手术后重度三尖瓣反流（TR）的外科治疗经验。方法回顾性分析自1999年2月至2009年12月上海交通大学医学院附属仁济医院31例左心瓣膜手术后重度TR患者的临床资料,男3例,女28例;年龄35~60岁（38.4±8.3岁）。31例左心瓣膜手术后重度TR患者均合并心房颤动,有不同程度的右心功能不全表现,其中心功能分级（NYHA）Ⅱ级3例,Ⅲ级24例,Ⅳ级4例。所有患者接受了三尖瓣手术,其中18例采用Carpentier-Edwards半硬环行三尖瓣成形术（TVP）,13例采用生物瓣行三尖瓣置换术（TVR）。对上述患者术前、术后的临床资料进行比较。结果围术期死亡2例,均死于心力衰竭,以右心功能衰竭为主。29例生存患者术后无严重并发症发生,均好转出院。随访29例,随访时间3个月~9年（5.3±2.5年）,随访期间均给予强心、利尿等治疗。术后3个月患者心功能均有明显改善（NYHA分级Ⅰ级3例,Ⅱ级19例,Ⅲ级5例,Ⅳ级2例）;超声心动图提示：TR明显改善,右心房内径（50.2±8.8 mm vs.63.1±12.4 mm,P=0.005）、右心室内径（28.3±7.1 mm vs.35.7±8.2mm,P=0.008）较术前明显缩小。结论对左心瓣膜手术后重度TR患者,早期应积极地行外科手术治疗;手术方式应根据患者三尖瓣的具体情况和手术者的经验,以选择置入半硬成形环的TVP为主,必要时采用生物瓣行TVR。但对有严重右心功能衰竭（NYHA分级Ⅳ级）患者需慎重选择手术治疗,应以内科保守治疗为主。
作者 汪永义 薛松 徐根兴 郑家豪 黄日太 刘沙 连锋 胡振雷 谢波 翟新明
机构地区 上海交通大学医学院附属仁济医院心胸外科
出处 《中国胸心血管外科临床杂志》 CAS 2011年第4期362-364,共3页 Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词 左心瓣膜手术 重度三尖瓣反流 外科手术
分类号 R654.2 [医药卫生—外科学]
  • 相关文献

参考文献11

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二级参考文献27

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共引文献26

同被引文献11

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二级引证文献15

中国胸心血管外科临床杂志
2011年 第4期

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