Objective To observe early and intermediate-term clinical outcomes of tricuspid valvuloplasty withannuloplasty ring for the treatment of secondary tricuspid regurgitation （TR） of patients with rheumatic heart disease. MethodsFrom December 2009 to September 2011, 41 patients with rheumatic heart disease underwent left-side heart valve replacementand concomitant tricuspid valvuloplasty with annuloplasty ring in Sichuan Jianyang People’s Hospital. There were 12 males and 29 females with their mean age of 49 （21-67） years. Preoperatively, there were 38 patients with atrial fibrillation, 13 patients with left atrial thrombus; 2 patients with trivial TR, 5 patients with mild TR, 11 patients with moderate TR, and 23 patients with severe TR. Twenty-eight patients received mitral valve replacement and 13 patients received mitral and aortic valve replacement. All the patients were followed up every 3 months at the outpatient department, and received color Doppler echocardiography examination to observe TR degree at the 6th postoperative month. Results Postoperative heart function improved by 2-3 class in all the patients. There were 39 patients with New York Heart Association (NYHA) classⅠorⅡ postoperatively, and postoperative heart function was significantly better than preoperative heart function（P＜0.05）. All the patients were followed up for 6-27 months, and there was no death during follow-up. Color Doppler echocardiography at the 6th postoperative month showed that TR degrees were significantly decreased than preoperative TR degrees. There were 39 patients with trivial or mild TR during follow-up, which was significantly different with preoperativeTR degree （P＜0.05）. Right ventricle dimension decreased from preoperative 20 mm to 17 mm during follow-up, which were statistically different （P＜0.05）. Conclusion Early and intermediate-term clinical outcomes of tricuspid valvuloplasty with annuloplasty ring for the treatment of TR are satisfactory, while further evaluation for its long-term outcome is needed.
Abstract： Objective To evaluate the surgical effect of ring annuloplasty using prosthetic vascular graft for the treatment of tricuspid regurgitation. Methods From July 2000 to July 2010, ring annuloplasty using prosthetic vascular graft was performed to a total of 56 patients with tricuspid regurgitation in Changhai Hospital of Second Military Medical University. There were 24 male patients and 32 female patients. Their mean age was（45.7±21.8）years (ranging from 14 to 73 years). All the patients were diagnosed as moderate to severe tricuspid regurgitation by color Doppler echocardiography examination, including 47 patients with rheumatic heart valve diseases, and 9 patients with congenital heart disease (Ebstein’s anomaly). All the 56 patients underwent ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation. Results There was no in-hospital death. Postoperatively, one patient had acute respiratory failure, one patient had acute kidney failure, and one patient had re-exploration for bleeding. All patients had none or mild tricuspid regurgitation by echocardiography examination one month after surgery. Forty eight patients were followed up from 1.0 to 9.5 years with a median follow-up time of 3.8 years. During follow-up, there was no late death, but one patient had brain embolism as an anticoagulation complication. Sixteen patients were in New York Heart Association (NYHA) functional classⅠ, 26 patients in NYHA classⅡ, and 6 patients in NYHA class Ⅲ. Thirty six patients had no tricuspid regurgitation, 10 patients had mild tricuspid regurgitation, and 2 patients had moderate tricuspid regurgitation by echocardiography examination during follow-up. Conclusion The early and mid-term follow-up results of ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation are satisfactory. It is a good choice for the surgical treatment of tricuspid regurgitation.
Objective To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique. Methods From January 2002 to August 2005, 70 patients were treated with tricuspid valve plasty. These patients were divided into modified De Vega annuloplasty group and traditional De Vega annuloplasty group randomly before operation. The tricuspid regurgitation （TR） were functional and secondary in all patients. The grade of TR and New York Heart Association（NYHA） functional class of two groups were analyzed by Ridit analysis. The changes of right ventricular end-diastolic dimension of two groups were analyzed by paired-sample t test. Results There was no statistically difference between two groups about preoperative characteristics. The follow-up time of modified De Vega annuloplasty group was 12.91±8.84 months and that of traditional De Vega annuloplasty group was 13.61±11.21 months. There was no significant difference between two groups. The outcome of follow-up was satisfactory. In modified De Vega annuloplasty group, there were 12 patient with no TR, 17 patient with mild TR, and 6 patients with moderate TR. There was no patient with severe TR. In traditional De Vega annuloplasty group, 7 patients were observed with no TR, 19 patients mild TR, 7 patients moderate TR and 2 patients severe TR. In modified De Vega annuloplasty group, 32 patients were in NYHA class Ⅰ, 2 patients in NYHA class Ⅱ and only 1 patient in NYHA class Ⅲ. As for traditional De Vega annuloplasty group, 31 patients were in NYHA class Ⅰ, 2 patients in NYHA class Ⅱ and 2 patients in NYHA class Ⅲ. The Ridit analysis showed that there was no significant difference about NYHA class between two groups. However, the difference of TR between two groups was statistically significant （P〈0.05）. The outcome of modified De Vega annuloplasty was superior to that of traditional De Vega technique. Paired-sample t test demonstrated that the modified De Vega annuloplasty could reduce the right ventricular end-diastolic dimension significantly （P〈0.05）. However, the right ventricular end-diastolic dimension of traditional De Vega annuloplasty groups did not change significantly （P 〉 0.05）. Conclusion The efficacy of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in patients with secondary TR.
ObjectiveTo analyze risk factors and long-term outcomes of surgical treatment for isolated tricuspid regurgitation (TR) after left-sided valve replacement. MethodsWe retrospectively analyzed clinical data of 65 patients who underwent surgical treatment for severe isolated TR after left-sided valve replacement in Guangdong Cardiovascular Institute from January 2000 to June 2013. There were 12 male and 53 female patients with their age of 37-72 (52.3±8.0) years. Fifty-nine patients had atrial fibrillation (AF). There were 61 patients with functional TR and 4 patients with rheumatic TR. Six patients were in New York Heart Association (NYHA) functional class Ⅱ,40 patients were in NYHA class Ⅲ,and 19 patients were in NYHA class Ⅳ.The duration between the first and second cardiac operation was 1-26 (11.2±4.7) years. Fifty-five patients received tricuspid valve replacement (TVR) and 10 patients received tricuspid valvuloplasty (TVP). ResultsEleven patients (16.9%) died postoperatively. Univariate analysis showed that male gender,right ventricular internal dimension,preoperative serum albumin level (ALB) direct bilirubin (DBil) level,cardiopulmonary bypass (CPB) time and preoperative NYHA functional class Ⅳ were significantly correlated with postoperative death. Preoperative cardiothoracic ratio(C/T) TR area,left ventricular ejection fraction (LVEF) pulmonary arterial systolic pressure (PAs) preoperative hemoglobin(HGB) level,creatinine (Cr) level,total bilirubin (TBil) level,alanine aminotransferase (ALT) level and the duration between the first and second cardiac operation were not significantly related with surgical mortality. Multivariate logistic regression analysis showed that preoperative NYHA functional class Ⅳ was an independent risk factor of in-hospital death (OR=7.23,95% CI:1.57-33.25,P=0.01). Among the 54 survivors,50 patients (92.6%) were followed up for 1-160(47.2±43.3) months. Five patients died during follow-up including 3 TVR patients with heart failure,1 TVR patient with aortic valve obstruction and 1 TVP patient with sudden cardiac arrest. One-year and 5-year survival rates of TVR patients were 95%±3% and 89%±7% respectively,and 1-year and 5-year survival rates of TVP patients were 100% and 80%±18% respectively(P=0.92). Cox regression analysis showed that preoperative Cr level was an independent risk factor of long-term mortality (HR=1.10,95% CI:1.03-1.17,P<0.01). ConclusionIn-hospital mortality of patients with isolated TR after left-sided valve replacement who undergo surgical treatment is significantly related with preoperative overall condition and heart function. Surgical therapy should be performed before severe heart failure occurs. Postoperative 5-year survival rate is good,and long-term mortality is related with preoperative Cr level.
Abstract： Ebstein anomaly is a relatively rare congenital heart malformation which can affect heart function significantly. It may cause right heart failure, even whole heart failure and eventually death. In recent years, the surgery has made much progress in dealing with the abnormal valve, improving the right ventricle function and pretreatment of its related complications. However, because of its complexity and diversity in pathological anatomy and clinical manifestations, the disease has not got an “almighty standard” to treat all pathological anatomy types of the deformity, or asurgery strategy to solve the practical problems encountered in all clinic situations. Furthermore, the therapeutic effect is also unsatisfactory. This article will review the advance of treatment of Ebstein anomaly and prevention of its related complications.