摘要:目的:探討改良De Vega環縮術與經典De Vega環縮術相比對于治療重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月對29例重度三尖瓣返流的患者行De Vega環縮術。其中16例行改良De Vega環縮術,13例行經典De Vega環縮術,隨訪比較兩組患者三尖瓣返流程度,右心室舒張期末內徑,EF值及心功能分級。以秩和檢驗分析研究兩組患者三尖瓣返流程度和心功能分級的差異,以t檢驗研究兩組患者右心室舒張末期內徑及EF值變化。結果:術前兩組患者一般指標無顯著差異。兩組患者隨訪時間無顯著差異。隨訪經典De Vega組重度返流1例,中度返流5例,輕度返流5例,微量及無返流2例;改良De Vega組無中、重度返流,輕度返流8例,微量及無返流8例。經分析顯示兩組患者三尖瓣返流程度結果差異有統計學意義(Plt;0.05)。經典De Vega組心功能分級I級5例,II級7例,III級1例;改良De Vega組I級7例,II級8例,III級1例,兩組患者心功能差異無統計學意義(Pgt;0.05)。兩組患者右室舒張期末內徑及EF值組內比較隨訪與術前差異均有統計學意義(Plt;0.05),隨訪時組間比較差異有統計學意義(Plt;0.05), 改良De Vega環縮術隨訪時右室舒張期末內徑縮小更顯著,射血分數改善更明顯。結論:改良De Vega環縮術治療重度三尖瓣返流效果優于經典De Vega環縮術。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.
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.
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.