目的 探討組織多普勒（TDI）Tei指數評價房間隔缺損（ASD）無并發肺動脈高壓患者右室功能的改變。 方法 選取2012年3月－10月無并發肺動脈高壓的繼發孔型房間隔缺損患者31例（ASD組）及健康體檢者30例（對照組），應用TDI成像獲取三尖瓣環運動頻譜，測定頻譜圖上Aa 峰至S峰的時間（等容收縮時間，ICT），S峰的持續時間（射血時間，ET）和S峰至Ea峰的時間（等容舒張時間，IRT），計算右室Tei指數。房缺組Tei指數及相關參數與缺損大小和患者年齡作相關性研究。 結果 ASD損無并發肺動脈高壓患者右室等容收縮時間（ICT）低于正常對照[（45 ± 7）、（59 ± 8）ms，P＜0.001]，右室等容舒張時間（IRT）高于正常對照[（85 ± 5）、（78 ± 14）ms，P＜0.01]，房缺組Tei指數低于正常對照（0.48 ± 0.03、0.52 ± 0.05，P＜0.001）。房缺組的缺損大小與Tei指數、ICT呈負相關（r=?0.61，P＜0.01；r=?0.44，P＜0.05），而患者年齡與Tei指數、ICT及IRT呈正相關（r=0.69，P＜0.001；r=0.75，P＜0.001；r=0.63，P＜0.001）。 結論 TDI Tei指數是無創、有效和快捷評價右室功能的方法；ASD無并發肺動脈高壓患者的ICT縮短，Tei指數減低，右室收縮和整體功能增強，而IRT延長，舒張功能受損；缺損越大，右室收縮和整體功能越強；年齡越大，右室整體功能相對減低。
Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification（NYHA）.All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05）. The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ（χ2=1.532，Pgt;0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.
Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.
Abstract:Objective To investigate clinical characteristics of patients with aortic valve disease and coronary artery disease （CAD）， and improve the pertinence of clinical management. Methods Clinical data of 78 patients who were older than 50 years and underwent isolated aortic valve replacement （AVR） in General Hospital of Shenyang Command from January to October 2010. All the patients were divided into two groups according to whether they had CAD：20 patients with CAD in the CAD group， including 19 males and 1 female with their average age of 64.6±8.3 years， and 58 patients without CAD in the control group， including 28 males and 30 females with their average age of 58.7±6.2 years. Clinical characteristics of AVR patients with CAD were analyzed by one-way analysis of variance and multiple factor analysis. Results One-way analysis showed that the incidence of old age （P=0.000）， male patients （P=0.004）， diabetes （P=0.004）， aortic regurgitation （P=0.034）， valvular lesion （P=0.028）， and postoperative mechanical ventilation time （P=0.008）of CAD group patients were significantly higher or longer than those of control group patients. Multiple factor analysis showed that independent clinical characteristics of AVR patients with CAD included male patients， old age， prolonged postoperative mechanical ventilation time， significantly decreased pulmonary arterial systolic pressure （PASP） at 6th postoperative month， and significant preoperative right ventricular diastolic dysfunction. Conclusion The screening age for possible CAD should be reasonably lowered if male patients with aortic valve disease have concomitant preoperative right ventricular diastolic dysfunction and/or tricuspid aortic valve degeneration. Patients undergoing isolated AVR need to take medications to reverse left ventricular remodeling for a long time to avoid severe arrhythmia.
ObjectiveTo investigate effect of cardiac function and tricuspid regurgitation (TR) degree of concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR), and provide an objective basis for clinical decision about concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR. MethodsA total of 36 patients who underwent MVR from April to October 2013 in Department of Cardiovascular Surgery, West China Hospital, Sichuan University were enrolled in this study. Preoperative echocardiography showed mild TR and tricuspid valve annular end-diastolic dimension (TVAEDD)/body surface area (BSA)>21 mm/m2. All the 36 patients were randomly divided into a tricuspid annuloplasty group (TAPG group, n=18, including 7 males and 11 females) and a no tricuspid annuloplasty group (NTAPG group, n=18, including 6 males and 12 females). One week and 6 months postoperative echocardiography were recorded. ResultsThere were no statistical differences in age, gender, heart rate, body surface area, preoperative cardiac function (NYHA), left atrium dimension (LAD), left ventricular dimension (LVD), maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension (RVD2), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) between the two groups (P>0.05). Six-months postoperative left atrial-ventricular diameter significantly reduced than that before surgery in the two groups (P<0.05). In the TAPG group, six-months postoperative right ventricle dimension (RVD1), right ventricular wall thickness (RVWT), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) significantly decreased, while percent shorting of tricuspid valve annulus (PSTVA) did not change significantly (P>0.05), TR degree improved significantly (P<0.05), right ventricular fractional area change (RVFAC) and right ventricular ejection fraction (RVEF) significantly increased (P<0.05). In the NTAPG group, compared with preoperative data, six-months postoperative RVD1, RVWT significantly increased, TVAEDD, TVAESD, PSTVA did not change significantly (P>0.05), RVEF reduced significantly (P<0.05), RVFAC increased significantly but less than that in the TAPG group at the same period, constituent ratio of TR changed significantly (P<0.05), but postoperative moderate or more TR were recorded in 6 patients. ConclusionConcomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent mitral valve replacement (MVR) can help to decrease RVD1, RVWT, TVAEDD and TVAESD, improve the constituent ratio of TR, and increase RVFAC and RVEF.
Right-sided cardiac valvular diseases have traditionally been considered less important than disease of mitral or aortic valve. However, severe tricuspid regurgitation could lead to right ventricle dysfunction and reduce patients' survival rate. In clinic setting, tricuspid valve disease should be paid more attention for patients with secondary tricuspid regurgitation caused by left-sided valvular surgery combined with irreversible annular dilatation increasing the risk of re-operation. In this review, we summarize the epidemiology, anatomy, pathology, diagnosis, ultrasound and cardiac magnetic resonance imaging findings in patients with tricuspid regurgitation.