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find Keyword "三尖瓣反流" 29 results
  • Risk Factors of Secondary Tricuspid Regurgitation: A Meta-Analysis

    Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.

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  • 改良三尖瓣成形术的效果评价

    目的 比较一种改良三尖瓣成形术与Kay 成形术的成形效果,总结治疗经验。 方法 回顾性分析江苏省人民医院2006 年1 月至2008 年1 月60 例功能性三尖瓣反流患者的临床资料。按手术方式不同将60 例患者分为两组:改良三尖瓣成形术组(改良组),30 例,其中男14 例,女16 例;年龄(42.80±5.70)岁;Kay 成形术组,30 例,其中男15 例,女15 例;年龄(45.30±8.30)岁。术前两组患者的年龄、性别、心功能分级(NYHA)和三尖瓣反流分级差异均无统计学意义(P > 0.05)。比较两组患者术前、术后住院及术后随访期间的右心房横径、右心室舒张期末内径和三尖瓣反流面积。 结果 两组患者手术时间、体外循环时间、住重症监护室时间、呼吸机辅助时间、住院时间差异均无统计学意义。术后全部患者痊愈出院。改良组随访时间为(19.62±8.65)个月,远期1 例死于肺部感染;随访三尖瓣无反流13 例,Ⅰ级反流14 例,Ⅱ级反流2 例,Ⅲ级反流1 例,无Ⅳ级反流。Kay 成形术组随访时间为(18.96±9.23)个月,远期死亡2 例,分别死于顽固性右心衰竭和脑出血;随访无三尖瓣反流9 例,Ⅰ级反流12 例,Ⅱ级反流5 例,Ⅲ级反流2 例,Ⅳ级反流2 例。术后早期改良组和Kay 成形术组右心房横径[(4.51±0.85)cm vs. (5.69±1.21) cm]、右心室舒张期末内径[(2.85±0.45) cm vs.( 3.47±0.83) cm] 和三尖瓣反流面积[(4.17±2.54) cm2 vs.( 25.12±2.39 cm2)] 较术前均明显下降(P < 0.05);术后随访改良组和Kay成形术组右心房横径[(3.95±0.66) cm vs.( 4.52±0.38) cm,P=0.705] 差异无统计学意义,右心室舒张期末内径[(2.59±0.63)cm vs.( 2.98±0.47) cm, P=0.002] 和三尖瓣反流面积[(8.76±3.45) cm2 vs.( 12.16±5.28) cm2, P=0.004] 改良组优于Kay 成形术组。 结论 改良三尖瓣成形术的远期成形效果优于Kay 成形术。

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • 51例Ebstein畸形的外科治疗

    目的 总结Ebstein 畸形的外科治疗经验。 方法 回顾性分析2002年1月至2011年8月河南省胸科医院51例Ebstein畸形患者经外科手术治疗的临床资料,其中男22例,女29例;平均年龄15.8 (0.8~48.0)岁;平均体重35.3 (7.0~68.0) kg。Carpentier分型A型12例、B型34例、C型5例。超声心动图(UCG)提示:三尖瓣轻度反流7例,中度反流8例,重度反流36例。手术中应用褥式缝合上提隔瓣和后瓣,平行折叠房化右心室加三尖瓣环缩术21例,Carpentier法8例,二瓣化法11例,纵向折叠房化心室加三尖瓣成形术4例,三尖瓣机械瓣置换术3例,生物瓣置换术2例;另有2例因右心室发育不良仅做双向格林手术。17例患者于三尖瓣成形术后加做双向格林手术。 结果 围术期死亡2例,均死于低心排血量。术后随访49例,平均随访时间32 (2~102)个月。随访期间心功能分级(NYHA)Ⅰ级30例、Ⅱ级19例;三尖瓣中度反流8例,轻度反流6例,无反流35例。3例三尖瓣机械瓣置换术患者的机械瓣、2例生物瓣置换术的生物瓣功能均正常。患者恢复正常的生活或工作,无需再次手术患者。 结论 对Ebstein 畸形要根据不同的病情采取相应的手术治疗方法,可以获得良好的手术效果。

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Clinical Outcomes of Tricuspid Annuloplasty Using a C-type Ring Made of Autologous Pericardium

    Abstract: Objective To evaluate clinical outcomes of tricuspid annuloplasty using a C-type ring made of autologous pericardium for the treatment of functional tricuspid regurgitation (TR). Methods Eleven patients underwent tricuspid annuloplasty in Guizhou Provincial People’s Hospital between March 2009 and January 2011, including 5 male patients and 6 female patients with their age of 32-57 (43.80±12.20) years. There were 3 patients with mild TR, 7 patients with moderate TR, and 1 patient with severe TR. Concomitant procedures included mitral valve replacement and/or aortic valve replacement and/or left atrial thrombectomy. The C-type ring was created using a strip of pericardium after 0.8% glutaraldehyde fixation for 15 minutes. Interrupted horizontal mattress suture was used to secure the C-type ring to the tricuspid annulus. Hear function and echocardiography were examined during follow-up. Results There was no in-hospital death, and the hospital stay was 15-28 (21.10±3.80) days. All the patients were followed up for 8-28 (18.50±7.00)months. There was no death or reoperation because of TR or tricuspid stenosis during follow-up. Ten patients had TR during follow-up, including 9 patients with mild TR and 1 patient with mild to moderate TR, but there was no patient with severe TR. The degree of TR during follow-up was significantly reduced than preoperative degree (Z =-2.81,P<0.05). Preoperative and postoperative right ventricular dimension (19.95±5.11 mm vs. 21.57±12.81 mm,P=0.705) and right atrial dimension(37.55±6.79 mm vs. 35.55±5.22 mm,P=0.317)were not statistically different. Conclusion Tricuspid annuloplasty using a C-type ring made of autologous pericardium has satisfactory clinical outcomes for patients with functional TR.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Mild Functional Tricuspid Regurgitation Approach to Mitral Valve Repair

    Abstract: Objective To explore whether clinically mild functional tricuspid regurgitation should be addressed at the time of mitral valve repair (MVP) for moderate or severe mitral regurgitation due to myxomatous degeneration. Methods We retrospectively analyzed the outcomes of 135 patients with moderate or severemitral regurgitation due to myxomatous degeneration with mild functional tricuspid regurgitation. All patients were treated between January 1993 and March 2008 in the Department of Cardiothoracic Surgery of Changhai Hospital, the Second Military Medical University. We divided the patients into a MVP group (n=76) and a MVP+tricuspid valvuloplasty (TVP) group(n=59) according to whether they underwent combined TVP, and observed the perioperative mortality rate, degree of tricuspid regurgitation, and compared survival rate, and freedom from longterm moderate or severe tricuspid regurgitation after operation. Cox regression was used to analyzethe risk factors for longterm moderate or severe tricuspid regurgitation after operations. Results (1) There were no deaths during the perioperative period, and postoperative transthoracic echocardiography of all patients indicated that tricuspid regurgitation was mild or less. (2) Survival rate at 5 years, 10 years after operations in MVP group was 98.4%, 95.0%, respectively, and survival rate at 5 years, 10 years after operations in MVP+TVP group was 100.0%, 93.7%, respectively, and there was no significant difference in the survival rate after operations between the two groups(P=0.311), butthere was a significant difference in the freedom from longterm moderate or severe tricuspid regurgitation after operations between the two groups (P=0.040). Multivariate Cox regression showed that preoperative pulmonary artery pressure gt;30 mm Hg (95%CI 1.127 to 137.487, P=0.040 )and atrial fibrillation (95%CI 1.177 to 23.378, P=0.030) wereindependent risk factors for longterm moderate or severe tricuspid regurgitation afteroperations.Conclusion TVP is necessary for most patients undergoing MVP for moderate or severe mitral regurgitation due to myxomatous degeneration who have coexistent mild functional tricuspid regurgitation, especially those patients with preoperative pulmonary artery pressure gt;30 mm Hg or atrial fibrillation.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • Surgical Repair of Functional Tricuspid Regurgitation: An Old Issue Revisited

    Abstract: Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • Preliminary Clinical Observation of Tricuspid Annuloplasty Adopting Tricuspid Annulus Diameter as Surgical Indication

    Objective To observe whether the adoptation of tricuspid annulus diameter as surgical indication for tricuspid annuloplasty will reduce the occurrence of moderate-severe tricuspid regurgitation(TR) in patients after mitral valve replacement (MVR). Methods Between April 2005 and June 2006, MVR was performed in 56 patients with no or mild TR in our Department. The patients were divided into two groups according to tricuspid annulus diameter(TAD)/body surface area (BSA)≥21mm/m2. Tricuspid annuloplasty group(TA group): 22 cases, male 8, female 14, age 45.0±7.7 years, TAD 36.8±3.8mm, BSA 1.57±0.15m2, New York Heart Association(NYHA) functional class Ⅲ/Ⅲ-Ⅳ 18/4, sinus rhythm(SR)/atrial fibrillation (AF) 2/20. Notricuspid annuloplasty group (NTA group): 34 cases, male 9, female 25, age 42.9±11.0 years, TAD 28.5±4.4mm, BSA 1.58±0.13m2, NYHA Ⅲ/Ⅲ-Ⅳ 28/6, SR/AF 9/25. Kay annuloplasty was performed for TA group patients. The patients were followed in outpatient clinical regularly and evaluated by echocardiography at 6 months after operation. Results All patients recovered and were discharged from hospital. The duration of follow-up was 11.0±2.4 months. Except 2 cases, all patients received echocardiography evaluation at 6 months after operation. There were no significantly differences between two groups patients in general clinical characteristics (Pgt;0.05). Compared with NTA group before operation, right atrial diameter (RAD, 49.3±7.0mm) and TAD(36.8±3.8mm) were bigger and more mild TR in TA group (Plt;0.05). RAD(44.1±8.9mm) and TAD(28.9±6.1mm) reduced and the proportion of TR degree improved (Plt;0.05) in TA group but did not occur in NTA group after surgery (Pgt;0.05). There were three cases of moderate TR in NTA group. Conclusion Tricuspid annuloplasty adopting TAD as surgical indication may reduce the occurrences of postoperative moderate-severe TR for patients of MVR with no or mild preoperative TR.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Clinical Characteristics and Management of Patients with Severe Tricuspid Regurgitation after Mitral Valve Surgery

    Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • The Regression, Residue or Progression of Tricuspid Regurgitation after Mitral Valve Replacement

    Objective To examine the regression, residue, or progression of tricuspid regurgitation (TR) after mitral valve replacement so as to improve the clinical evaluation and management of TR. Methods From January 1998 to December 2003, a total of 287 consecutive patients of mitral valve replacement were followed and reviewed for this study. There were 86 male patients and 201 female patients whose ages ranged from 15 to 66 years (41.0±11.0 years). The predominant mitral vane lesion was stenosis in 199 patients (69%), regurgitation in 66 patients (23%) and mixed in 22 patients (8%). A total of 201 patients (70%) had atrial fibrillation and 86 patients (30%) were in sinus rhythm. According to ratio of maximal regurgitation area to right atrial area TR was graded as mild (+), mild-moderate (+/++) moderate (++) moderate-severe (++/+++) and severe (+++). There were 101 mild TR (36.7%), 5 mild-moderate(1.8%), 27 moderate (9.8%), 2 moderate-severe (0.7%) and 21 severe (7.6%). Depending on the surgical findings tricuspid annuloplasty was performed. The patients were followed in outpatient clinical and had echocardiography evaluation regularly. Results The follow-up ranged from 2 to 7 years (4.0±1.6 years). Twelve patients were lost during the follow-up periods. Compared with preoperation, clinical condition of the majority of patients was improved after surgery. The diameter of left atrium, right atrium, left ventricle and right ventricle decreased significantly after operation (P〈0.01). The ejection fraction and fraction of shorting increased significantly after surgery (P〈0.05). However there were no significantly changes between pre- TR and post- TR in these patients (P〉0.05). Tricuspid annuloplasty was not performed for 129 patients who had TR because TR was judged intraoperatively not to be severe. Of those patients, TR regressed in 54 patients, improved in 12 patients, did not change in 46 patients and progressed in 17 patients respectively after surgery. There were 27 patients who received De Vega tricuspid annuloplasty. Among them, TR regressed in 10 patients, improved in 12 patients and did not change in 5 patients respectively after surgery. Conclusion It is not adequate to evaluate the degree of TR in mitral valve diseases with rate of maximal regurgitation area to right atrial area. It should be improved to adopt intraoperative findings for tricuspid annuloplasty. TR may occur in patients who do not have TR before operation.

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • SHORT-TERM EFFECTIVENESS ANALYSIS OF THREE DIFFERENT TRICUSPID VALVE PLASTY FOR FUNCTIONAL TRICUSPID REGURGITATION

    Objective To compare and evaluate the short-term outcomes of 3 different tricuspid valve plasty for functional tricuspid regurgitation (TR) in patients with rheumatic heart disease. Methods Between October 2010 and June 2011, 148 patients with rheumatic heart disease undergoing left heart valve replacement and tricuspid valve plasty for functional TR were enrolled in the study. There were 32 males and 116 females with an average age of 47.5 years (range, 15-66 years). The patients were divided into 3 groups depending on tricuspid valve plasty: Cosgrove-Edwards annuloplasty ring group (annuloplasty ring group, 58 cases), Kay annuloplasty group (Kay group, 61 cases), and DeVega annuloplasty group (DeVaga group, 29 cases). There was no significant difference in general data among groups (P gt; 0.05), except more severe TR degree, higher atrial fibrillation, and higher radiofrequency ablation in annuloplasty ring group (P lt; 0.05). Perioperative data were recorded. The heart function was evaluated according to the standard of New York Heart Association (NYHA). Echocardiography (ECG) was used to record the TR class during perioperative period and follow-up. Results After operation, 1 case in Kay group and 1 case in annuloplasty ring group were dead because of low cardiac output syndrome. Pneumonia happened in 2 cases of Kay group and in 1 case of annuloplasty ring group; re-operation was performed in 1 case of annuloplasty ring group because of sternal dehiscence. There was no significant difference in perioperative complication among 3 groups (P=0.840). The TR degree was significantly improved at discharge when compared with preoperative degree in 3 groups (P lt; 0.001). A total of 146 patients were followed up 6-12 months (mean, 7.3 months). The NYHA grade of 3 groups at last follow-up was improved when compared with preoperative grade (P lt; 0.001), but no significant difference among 3 groups (χ2=0.120, P=0.942). The TR degree at last follow-up was all improved in 3 groups when compared with preoperative degree (P lt; 0.001); the improved efficiency showed significant difference among 3 groups (χ2=26.827, P=0.000), it was significantly better in annuloplasty ring group than in the other 2 groups (P lt; 0.001), but no significant difference between DeVega group and Kay group (Z=1.467, P=0.142). Conclusion The early improved efficiency of TR after Cosgrove-Edwards annuloplasty is superior to that of Kay annuloplasty and DeVega annuloplasty.

    Release date:2016-08-31 04:05 Export PDF Favorites Scan
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