• 中國(guó)醫(yī)學(xué)科學(xué)院北京協(xié)和醫(yī)學(xué)院阜外心血管病醫(yī)院心血管病研究所成人外科中心， 北京 100037;

繼發(fā)于左心系統(tǒng)瓣膜病變的三尖瓣關(guān)閉不全，多為三尖瓣瓣環(huán)擴(kuò)大導(dǎo)致的功能性三尖瓣關(guān)閉不全，也有少數(shù)患者同時(shí)合并三尖瓣風(fēng)濕性等器質(zhì)性改變。對(duì)三尖瓣反流的處理，目前主張如果能通過(guò)瓣膜成形方法恢復(fù)三尖瓣瓣膜功能，應(yīng)盡量行三尖瓣成形手術(shù)。三尖瓣成形方法主要包括線性成形和人工瓣環(huán)成形技術(shù) ,但目前各種手術(shù)成形方法的適應(yīng)證選擇和臨床應(yīng)用尚無(wú)統(tǒng)一的標(biāo)準(zhǔn)，多年來(lái)一直是困擾心臟外科醫(yī)師的難題和研究熱點(diǎn)，是否需要同期行三尖瓣成形術(shù)，采用什么成形方法才能達(dá)到最佳的三尖瓣成形效果。因此，對(duì)繼發(fā)性三尖瓣關(guān)閉不全患者三尖瓣病變程度的判定、矯治標(biāo)準(zhǔn)及手術(shù)方法等進(jìn)行綜述。

引用本文： 潘世偉,胡盛壽. 繼發(fā)性三尖瓣關(guān)閉不全的外科治療進(jìn)展. 中國(guó)胸心血管外科臨床雜志, 2012, 19(2): 185-188. doi: 復(fù)制

1. 　Solomon NA, Lim RC, Nand P, et al. Tricuspid valve replacement: bioprosthetic or mechanical valve? Asian Cardiovasc Thorac Ann, 2004, 12（2）: 143-148.
2. 　Kaplan M, Kut MS, Demirtas MM, et al. Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical. Ann Thorac Surg, 2002, 73（2）: 467-473.
3. 　Guenther T, Noebauer C, Mazzitelli D, et al.Tricuspid valve surgery:a thirty-year assessment of early and late outcome.Eur J Cardiothorac Surg, 2008, 34（2）: 402-409.
4. 　Matsuyama K, Matsumoto M, Sugita T, et al.De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation.J Heart Valve Dis, 2001, 10（4）: 520-524.
5. 　Tang GH, David TE, Singh SK, et al.Tricuspid valve repair with an annuloplastyring results in improved long-term outcomes.Circulation, 2006, 114（1 Suppl）: I577-I581.
6. 　周睿, 徐方杰, 陳佩莉, 等.三尖瓣環(huán)成形治療功能性三尖瓣反流245例總結(jié).中國(guó)循環(huán)雜志, 2009, 24（1）: 52-55.
7. 　McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127（3）: 674-685.
8. 　Shiran A, Sagie A.Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management.J Am Coll Cardiol, 2009, 53（5）: 401-408.
9. 　Di Mauro M, Bivona A, Iacò AL, et al. Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation.Eur J Cardiothorac Surg, 2009, 35（4）: 635-640.
10. 　Bemal JM, Morales D, Revuelta C, et a1. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg, 2005, 130: 498-503.
11. 　Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgiration after mitral valve surgery. Ann Thorac Surg, 2003, 75（6）: 1826-1828.
12. 　Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol, 2006, 48（3）: e1-e148.
13. 　Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European society of cardiology. Eur Heart J, 2007, 28（2）: 230-268.
14. 　Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79（1）: 127-132.
15. 　Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1（1）: 80-86.
16. 　Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation later after mitral valve replacement： clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8（1）: 57-62.
17. 　Henein MY, O’Sullivan CA, Li W, et al. Evidence for rheumatic valve disease in patients with severe tricuspid regurgitation long after mitral valve surgery: the role of 3D echo reconstruction. J Heart Valve Dis, 2003, 12（5）: 566-572.
18. 　Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35（4 Suppl）: I63-I69.
19. 　Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98（2）: 236-242.
20. 　Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent of residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation, 2006, 114: (1 Suppl ): I582-I587.
21. 　Fukuda S, Gillinov AM, McCarthy PM, et al. Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20（11）: 1236-1242.
22. 　潘世偉, 胡盛壽, 許建屏, 等.核素肺灌注顯像對(duì)瓣膜性心臟病合并肺動(dòng)脈高壓病人的手術(shù)療效觀察.中華胸心血管外科雜志, 2010, 26（4）: 240-243.
23. 　Holper K, Haehnel JC, Augustin N, et a1. Surgery for tricuspid insuficiency：long-term follow-up after De Vega annuloplasty. Thorac Cardiovasc Surg, 1993, 41（1）: 1-8.
24. 　McCarthy JF, Cosgrove DM 3rd. Tricuspid valve repair with the Cosgrove-Edwards Annuloplasty System. Ann Thorac Surg, 1997, 64（1）: 267-268.
25. 　潘世偉, 胡盛壽, 許建屏, 等.成形軟環(huán)應(yīng)用于三尖瓣關(guān)閉不全修復(fù)的療效評(píng)價(jià). 中國(guó)循環(huán)雜志, 2009, 24（5）: 379-382.
26. 　Filsoufi F, Salzberg SP, Coutu M, et al. A three-dimensional ring annuloplasty for the treatment of tricuspid regurgitation. Ann Thorac Surg, 2006, 81（6）: 2273-2277.
27. 　Calafiore AM, Lacò AL, Contini M, et al. A single-size band, 50 mm long, for tricuspid annuloplasty. Eur J Cardiothorac Surg, 2008, 34（3）: 677-679.
28. 　Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34（4）: 908-910.
29. 　Kappert U, Tugtekin SM, Ouda A, et al. Right ventricular reduction as an adjunct procedure in tricuspid valve repair. Ann Thorac Surg, 2008, 85（5）: e27-e29.
30. 　Sasaki T, Takahashi Y, Ando M, et a1. Edge-to-edge tricuspid valve repair in hypoplastic left heart syndrome. Gen Thorac Cardiovasc Surg, 2007, 55（12）: 505-507.
31. 　De Bonis M, Lapenna E, La Canna G, et a1. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. Eur J Cardiothorac Surg, 2004, 25（5）: 760-765.
  1. 1. 　Solomon NA, Lim RC, Nand P, et al. Tricuspid valve replacement: bioprosthetic or mechanical valve? Asian Cardiovasc Thorac Ann, 2004, 12（2）: 143-148.
  2. 2. 　Kaplan M, Kut MS, Demirtas MM, et al. Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical. Ann Thorac Surg, 2002, 73（2）: 467-473.
  3. 3. 　Guenther T, Noebauer C, Mazzitelli D, et al.Tricuspid valve surgery:a thirty-year assessment of early and late outcome.Eur J Cardiothorac Surg, 2008, 34（2）: 402-409.
  4. 4. 　Matsuyama K, Matsumoto M, Sugita T, et al.De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation.J Heart Valve Dis, 2001, 10（4）: 520-524.
  5. 5. 　Tang GH, David TE, Singh SK, et al.Tricuspid valve repair with an annuloplastyring results in improved long-term outcomes.Circulation, 2006, 114（1 Suppl）: I577-I581.
  6. 6. 　周睿, 徐方杰, 陳佩莉, 等.三尖瓣環(huán)成形治療功能性三尖瓣反流245例總結(jié).中國(guó)循環(huán)雜志, 2009, 24（1）: 52-55.
  7. 7. 　McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127（3）: 674-685.
  8. 8. 　Shiran A, Sagie A.Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management.J Am Coll Cardiol, 2009, 53（5）: 401-408.
  9. 9. 　Di Mauro M, Bivona A, Iacò AL, et al. Mitral valve surgery for functional mitral regurgitation: prognostic role of tricuspid regurgitation.Eur J Cardiothorac Surg, 2009, 35（4）: 635-640.
  10. 10. 　Bemal JM, Morales D, Revuelta C, et a1. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg, 2005, 130: 498-503.
  11. 11. 　Matsuyama K, Matsumoto M, Sugita T, et al. Predictors of residual tricuspid regurgiration after mitral valve surgery. Ann Thorac Surg, 2003, 75（6）: 1826-1828.
  12. 12. 　Bonow RO, Carabello BA, Chatterjee K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol, 2006, 48（3）: e1-e148.
  13. 13. 　Vahanian A, Baumgartner H, Bax J, et al. Guidelines on the management of valvular heart disease: the task force on the management of valvular heart disease of the European society of cardiology. Eur Heart J, 2007, 28（2）: 230-268.
  14. 14. 　Dreyfus GD, Corbi PJ, Chan KM, et al. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg, 2005, 79（1）: 127-132.
  15. 15. 　Groves PH, Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis, 1992, 1（1）: 80-86.
  16. 16. 　Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation later after mitral valve replacement： clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8（1）: 57-62.
  17. 17. 　Henein MY, O’Sullivan CA, Li W, et al. Evidence for rheumatic valve disease in patients with severe tricuspid regurgitation long after mitral valve surgery: the role of 3D echo reconstruction. J Heart Valve Dis, 2003, 12（5）: 566-572.
  18. 18. 　Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation, 1967, 35（4 Suppl）: I63-I69.
  19. 19. 　Kim HK, Kim YJ, Park JS, et al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol, 2006, 98（2）: 236-242.
  20. 20. 　Fukuda S, Gillinov AM, McCarthy PM, et al. Determinants of recurrent of residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation, 2006, 114: (1 Suppl ): I582-I587.
  21. 21. 　Fukuda S, Gillinov AM, McCarthy PM, et al. Echocardiographic follow-up of tricuspid annuloplasty with a new three-dimensional ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20（11）: 1236-1242.
  22. 22. 　潘世偉, 胡盛壽, 許建屏, 等.核素肺灌注顯像對(duì)瓣膜性心臟病合并肺動(dòng)脈高壓病人的手術(shù)療效觀察.中華胸心血管外科雜志, 2010, 26（4）: 240-243.
  23. 23. 　Holper K, Haehnel JC, Augustin N, et a1. Surgery for tricuspid insuficiency：long-term follow-up after De Vega annuloplasty. Thorac Cardiovasc Surg, 1993, 41（1）: 1-8.
  24. 24. 　McCarthy JF, Cosgrove DM 3rd. Tricuspid valve repair with the Cosgrove-Edwards Annuloplasty System. Ann Thorac Surg, 1997, 64（1）: 267-268.
  25. 25. 　潘世偉, 胡盛壽, 許建屏, 等.成形軟環(huán)應(yīng)用于三尖瓣關(guān)閉不全修復(fù)的療效評(píng)價(jià). 中國(guó)循環(huán)雜志, 2009, 24（5）: 379-382.
  26. 26. 　Filsoufi F, Salzberg SP, Coutu M, et al. A three-dimensional ring annuloplasty for the treatment of tricuspid regurgitation. Ann Thorac Surg, 2006, 81（6）: 2273-2277.
  27. 27. 　Calafiore AM, Lacò AL, Contini M, et al. A single-size band, 50 mm long, for tricuspid annuloplasty. Eur J Cardiothorac Surg, 2008, 34（3）: 677-679.
  28. 28. 　Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34（4）: 908-910.
  29. 29. 　Kappert U, Tugtekin SM, Ouda A, et al. Right ventricular reduction as an adjunct procedure in tricuspid valve repair. Ann Thorac Surg, 2008, 85（5）: e27-e29.
  30. 30. 　Sasaki T, Takahashi Y, Ando M, et a1. Edge-to-edge tricuspid valve repair in hypoplastic left heart syndrome. Gen Thorac Cardiovasc Surg, 2007, 55（12）: 505-507.
  31. 31. 　De Bonis M, Lapenna E, La Canna G, et a1. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. Eur J Cardiothorac Surg, 2004, 25（5）: 760-765.