CAJ | 학술논문

目的探讨在瓣膜置换术同期行三尖瓣成形术的合理手术指征、方法及围术期的处理.方法回顾性分析2005年12月至2009年1月间行三尖瓣成形术治疗中度至重度功能性三尖瓣关闭不全126例患者的临床资料,其中行Devega成形61例,人工环成形65例.同时行二尖瓣置换84例,二尖瓣+主动脉瓣置换42例.结果术后早期死亡4例,死于顽固性心力衰竭,病死率为3.2％,以术后第2年随访结果做为对比分析观测点,获访114例,心功能明显改善.心脏超声示右心房及右心室较术前明显缩小.共有20例仍有中度以上返流.结论在瓣膜置换术中据三尖瓣环扩大的部位及返流程度使用三尖瓣成形环进行三尖瓣成形具有更良好的中期疗效,围术期及术后加强强心、利尿及扩血管治疗有效降低肺动脉高压,可进一步提高三尖瓣成形近、远期疗效.
목적 탐토재판막치환술동기행삼첨판성형술적합리수술지정、방법급위술기적처리.방법 회고성분석2005년12월지2009년1월간행삼첨판성형술치료중도지중도공능성삼첨판관폐불전126례환자적림상자료,기중행Devega성형61례,인공배성형65례.동시행이첨판치환84례,이첨판+주동맥판치환42례.결과 술후조기사망4례,사우완고성심력쇠갈,병사솔위3.2％,이술후제2년수방결과주위대비분석관측점,획방114례,심공능명현개선.심장초성시우심방급우심실교술전명현축소.공유20례잉유중도이상반류.결론 재판막치환술중거삼첨판배확대적부위급반류정도사용삼첨판성형배진행삼첨판성형구유경량호적중기료효,위술기급술후가강강심、이뇨급확혈관치료유효강저폐동맥고압,가진일보제고삼첨판성형근、원기료효.
Objective To investigate the operation indications,surgical procedures and peri -operative management of functional tricuspid insufficiency (FTI) secondary to rheumatic valve disease.Methods Tricuspid annuloplasty was performed in 126 patients from Dec 2005 to Jan 2009 with rheumatic valve disease and FTI.They were divided into devegar procedure group ( n =61 ),and ring annuloplasty group ( n =65 ).All patients underwent in addition one - stage valve replacement including mitral valve replacement in 84 cases and combined aortic and mitral valve replacement in 42 cases.Results Early mortality was 4 cases (3.2％).Follow - up was made in 114 patients for 2 years.Four patients died of cardiac failure,and the others were considerably improved in quality of life.Diameter of right atriums and ventricles was significantly shorter than that preoperatively.Mild to moderate tricuspid insufficiency remained in 20 cases.Conclusions According to location of tricuspid annulus dilatation and degree of FTI,Ring annuloplasty was an effective treatment for functional tricuspid regurgitation with better midterm result.Diuretics and vasodilators are helpful to reduce pulmonary artery hypertension and improve long -term effect.