人工腱索移植治疗三尖瓣脱垂伴重度关闭不全_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

刘浩 , 姜兆磊 , 丁士骜 , 徐方杰 , 汤敏 ,  梅举

上海交通大学医学院附属新华医院心胸外科（上海 200092）;

Corresponding author：

梅举, Email: ju_mei63@126.com

Keywords：

人工腱索; 三尖瓣成形; 三尖瓣关闭不全; 疗效

DOI：

10.7507/1007-4848.202002031

Video：

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目的初步探讨三尖瓣人工腱索移植术治疗三尖瓣脱垂伴重度关闭不全的安全性和可靠性，并总结其应用经验。方法回顾性分析 2006 年 10 月至 2019 年 8 月在上海交通大学医学院附属新华医院行三尖瓣人工腱索移植 15 例患者的临床资料，其中男 9 例、女 6 例，年龄 7～57 岁。分析手术临床效果。结果全组患者体外循环时间（86.5±35.9）min，主动脉阻断时间（56.5±21.5）min。无围术期死亡病例，术后 1 例患者出现并发症（窦性心动过缓、阵发性房室传导阻滞）。随访时间 5 个月至 10 年，随访期间无死亡患者，有 2 例（13.3%）患者出现轻度三尖瓣关闭不全，其余患者三尖瓣功能良好。结论人工腱索移植可以作为三尖瓣成形的有效治疗手段，该方法可有效纠正由于腱索断裂、冗长、缺如等原因导致的三尖瓣脱垂，并取得良好疗效。

Citation： 刘浩, 姜兆磊, 丁士骜, 徐方杰, 汤敏, 梅举. 人工腱索移植治疗三尖瓣脱垂伴重度关闭不全. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1491-1494. doi: 10.7507/1007-4848.202002031 Copy

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2.	El-Eshmawi A, Pandis D, Adams DH, et al. Tricupid valve surgery: repair and replacement. Minerva Cardioangiol, 2018, 66(6): 700-712.
3.	Kay JH, Maselli-Campagna G, Tsuji KK. Surgical treatment of tricuspid insufficiency. Ann Surg, 1965, 162: 53-58.
4.	De Vega NG. Selective, adjustable and permanent annuloplasty. An original technic for the treatment of tricuspid insufficiency. Rev Esp Cardiol, 1972, 25(6): 555-556.
5.	Carpentier A, Deloche A, Hanania G, et al. Surgical management of acquired tricuspid valve disease. J Thorac Cardiovasc Surg, 1974, 67(1): 53-65.
6.	Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885-893.
7.	Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. Ann Thorac Surg, 2012, 93(2): 684-691.
8.	Ibrahim M, Rao C, Savvopoulou M, et al. Outcomes of mitral valve repair using artificial chordae. Eur J Cardiothorac Surg, 2014, 45(4): 593-601.
9.	Tabata M, Kasegawa H, Fukui T, et al. Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: a single-center experience of 700 cases. J Thorac Cardiovasc Surg, 2014, 148(5): 2033-2038.
10.	Althunayyan A, Petersen SE, Lloyd G, et al. Mitral valve prolapse. Expert Rev Cardiovasc Ther, 2019, 17(1): 43-51.
11.	Sassa T, Okamoto K, Tazume H, et al. Tricuspid valve repair with artificial chorda after previous ventricular septal defect repair. Ann Thorac Surg, 2017, 103(4): e335-e337.
12.	Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaf let augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
13.	Messika-Zeitoun, Thomson H, Bellamy M, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg, 2004, 128(2): 296-302.
14.	Marin D, Ramadan K, Hamilton C, et al. Tricuspid valve repair with artificial chordae in a 72-year-old woman. Thorac Cardiovasc Surg, 2011, 59(8): 495-497.
15.	Tian C, Pan S. Congenital absence of anterior papillary muscle of the tricuspid valve and surgical repair with artificial chordae. Interact Cardiovasc Thorac Surg, 2017, 24(2): 299-300.
16.	Shikata F, Nagashima M, Nishimura K, et al. Repair of congenitally absent chordae in tricuspid valve leaflet with hypoplastic papillary muscle using artificial chordae. J Card Surg, 2010, 25(6): 737-739.
17.	Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart, 2006, 92(Suppl 1): i2-i13.
18.	Hazelrigg SR, Boley TM, Magee MJ, et al. Comparison of staged thoracoscopy and median sternotomy for lung volume reduction. Ann Thorac Surg, 1998, 66(4): 1134-1139.
19.	Belluschi I, Del Forno B, Lapenna E, et al. Surgical techniques for tricuspid valve disease. Front Cardiovasc Med, 2018, 5: 118.
20.	Tang GH, David TE, Singh SK, et al. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation, 2006, 114(Suppl 1): i577-i581.
21.	Parolari A, Barili F, Pilozzi A, et al. Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review. Ann Thorac Surg, 2014, 98(6): 2255-2263.
22.	Lapenna E, De Bonis M, Verzini A, et al. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. Eur J Cardiothorac Surg, 2010, 37(6): 1297-1303.
23.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.

1. Antunes MJ, Rodríguez-Palomares J, et al. Management of tricuspid valve regurgitation: Position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease. Eur J Cardiothorac Surg, 2017, 52(6): 1022-1030.
2. El-Eshmawi A, Pandis D, Adams DH, et al. Tricupid valve surgery: repair and replacement. Minerva Cardioangiol, 2018, 66(6): 700-712.
3. Kay JH, Maselli-Campagna G, Tsuji KK. Surgical treatment of tricuspid insufficiency. Ann Surg, 1965, 162: 53-58.
4. De Vega NG. Selective, adjustable and permanent annuloplasty. An original technic for the treatment of tricuspid insufficiency. Rev Esp Cardiol, 1972, 25(6): 555-556.
5. Carpentier A, Deloche A, Hanania G, et al. Surgical management of acquired tricuspid valve disease. J Thorac Cardiovasc Surg, 1974, 67(1): 53-65.
6. Gillinov AM, Blackstone EH, Nowicki ER, et al. Valve repair versus valve replacement for degenerative mitral valve disease. J Thorac Cardiovasc Surg, 2008, 135(4): 885-893.
7. Bortolotti U, Milano AD, Frater RW. Mitral valve repair with artificial chordae: a review of its history, technical details, long-term results, and pathology. Ann Thorac Surg, 2012, 93(2): 684-691.
8. Ibrahim M, Rao C, Savvopoulou M, et al. Outcomes of mitral valve repair using artificial chordae. Eur J Cardiothorac Surg, 2014, 45(4): 593-601.
9. Tabata M, Kasegawa H, Fukui T, et al. Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: a single-center experience of 700 cases. J Thorac Cardiovasc Surg, 2014, 148(5): 2033-2038.
10. Althunayyan A, Petersen SE, Lloyd G, et al. Mitral valve prolapse. Expert Rev Cardiovasc Ther, 2019, 17(1): 43-51.
11. Sassa T, Okamoto K, Tazume H, et al. Tricuspid valve repair with artificial chorda after previous ventricular septal defect repair. Ann Thorac Surg, 2017, 103(4): e335-e337.
12. Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaf let augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
13. Messika-Zeitoun, Thomson H, Bellamy M, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg, 2004, 128(2): 296-302.
14. Marin D, Ramadan K, Hamilton C, et al. Tricuspid valve repair with artificial chordae in a 72-year-old woman. Thorac Cardiovasc Surg, 2011, 59(8): 495-497.
15. Tian C, Pan S. Congenital absence of anterior papillary muscle of the tricuspid valve and surgical repair with artificial chordae. Interact Cardiovasc Thorac Surg, 2017, 24(2): 299-300.
16. Shikata F, Nagashima M, Nishimura K, et al. Repair of congenitally absent chordae in tricuspid valve leaflet with hypoplastic papillary muscle using artificial chordae. J Card Surg, 2010, 25(6): 737-739.
17. Ho SY, Nihoyannopoulos P. Anatomy, echocardiography, and normal right ventricular dimensions. Heart, 2006, 92(Suppl 1): i2-i13.
18. Hazelrigg SR, Boley TM, Magee MJ, et al. Comparison of staged thoracoscopy and median sternotomy for lung volume reduction. Ann Thorac Surg, 1998, 66(4): 1134-1139.
19. Belluschi I, Del Forno B, Lapenna E, et al. Surgical techniques for tricuspid valve disease. Front Cardiovasc Med, 2018, 5: 118.
20. Tang GH, David TE, Singh SK, et al. Tricuspid valve repair with an annuloplasty ring results in improved long-term outcomes. Circulation, 2006, 114(Suppl 1): i577-i581.
21. Parolari A, Barili F, Pilozzi A, et al. Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review. Ann Thorac Surg, 2014, 98(6): 2255-2263.
22. Lapenna E, De Bonis M, Verzini A, et al. The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients. Eur J Cardiothorac Surg, 2010, 37(6): 1297-1303.
23. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.

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人工腱索移植治疗三尖瓣脱垂伴重度关闭不全

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