二尖瓣置换术后无肺高压病因的重度三尖瓣关闭不全患者临床及超声分析

Clinical and echocardiographic evaluations with severe tricuspid regurgitation without pulmonary hypertension after mitral valve replacement

关键词:  三尖瓣关闭不全  二尖瓣置换术  右心室重构

Key words:  tricuspid regurgitation  mitral valve replacement  right ventricular remodeling

摘要:

［目的］ 分析探讨二尖瓣置换术后无肺动脉高压的患者发生重度三尖瓣关闭不全（TR）的临床及超声特点，探讨机制、预后及治疗方法。［方法］ 收集风湿性心脏瓣膜病二尖瓣或二尖瓣和主动脉瓣双瓣置换术后因重度TR住院的患者12例，排除肺动脉压力明显升高（心脏超声测量右室收缩压>35 mmHg）及三尖瓣瓣膜畸形或破坏。对所有病例进行回顾性分析，总结临床特点及心脏超声表现。［结果］ 12例患者行瓣膜置换术前的风湿性瓣膜病病史较长，均超过20年，所有患者均有持续性房颤病史。心脏超声提示右心房及右心室扩大，左心房内径增大，左心室内径及收缩功能正常。置换的金属瓣或生物瓣形态及功能正常。无明显肺动脉高压，但三尖瓣瓣口探及重度反流，三尖瓣瓣膜及附属结构无明显异常：无瓣膜破损脱垂、腱索断裂，但三尖瓣瓣环扩张、瓣叶对合不良。［结论］ 风湿性心脏瓣膜病二尖瓣或双瓣置换术后无肺动脉高压的患者发生重度TR可能与右心室重构、三尖瓣环扩张、瓣叶对合不良有关。

Abstract:

［Objective］ To investigate the clinical and echocardiographic characteristics of severe tricuspid regurgitation without pulmonary hypertension after mitral valve replacement. ［Method］ Twelve patients with severe tricuspid regurgitation without pulmonary hypertension after mitral valve replacement were enrolled in. Clinical and echocardiographic characteristics of these patients were recorded. ［Result］ The history of all patients before mitral valve replacement was more than 20 years, and all had atrial fibrillation. Echocardiography revealed normal functions of prosthetic or bioprosthetic valves, and left ventricular contraction. The right ventricle and right atrium were dilated and right ventricle function was diminished. There was no pulmonary hypertension. The tricuspid valve leaflets appeared normal, but the tricuspid annulus was dilated, and there was malcoaptation of the tricuspid leaflets and severe TR. ［Conclusions］ After successful mitral valve replacement, severe tricuspid regurgitation is possibly related to tricuspid annular dilation, right ventricular dilation and tricuspid tenting, but not pulmonary hypertension.