The Hemodynamic Study And Clinical Of Functional Tricuspid Regurgitation

【Objective】：This paper attempted to (a) deeply study the mechanism of functionaltricuspid regurgitation (FTR) among patients underwent left heart valve replacementfrom the hemodynamic point of view，and to (b) analyse surgical methods for FTRand its effect.【Methods】：Analyzed clinical data、cardiac color Doppler ultrasound data of106patients and Swan-Ganz heart catheterization data of some FTR patients.Thesepatient’s data was collected randomly between Feb.2010and Feb.2012.we try to findout the hemodynamic characteristics of FTR.This paper want to find the optimaltiming of surgery and treatment programs for these kind pf people.【Result】Through the disease assessment, physical examination and heart colorDoppler ultrasound check on106completely random follow-up patients (the averagepostoperative time for left cardiac valve is13.40±4.24years) as well as the cardiaccatheterization and data analysis on some cases. According to the TR degree ofultrasound examination, the patients are divided into three groups of light, mediumand severe, and it is found that the rate of follow-up of patients with medium andsevere FTR accounts for62.26%. This study applies Tei and Z index as a gauge forthe right heart function. The study found that TR degree has the obvious correlationwith left and right heart structure and function; The Tei index of the FTR patients’right ventricle is obviously higher than that of the normal, which is gradually risingwith the increase of TR severity, and the statistics shows significant differencesexisting among light, medium and severe FTR patients. The Z index of FTR patients’right ventricle is lower than that of the normal, and the poorer cardiac function is, themore serious severe FTR, and the lower of Z index, RVEF and LVEF. Eight patientswith severe FTR in the group underwent the tricuspid valve replacement (TVR)during this period and4patients died, which suggests that it is not ideal to openthoracotomy again for TVR as for patients with severe FTR, with the higher deathrate during and following operation. 【Conclusion】Functional tricuspid regurgitation is the clinical manifestation of thestructural change and insufficiency of right ventricle or even the cardiac dysfunction.Functional tricuspid regurgitation is closely related to the long-term overload of rightventricle, interaction effects between left and right ventricles and the influence ofinterventricular septum on the function of the right ventricle. For patients with severeFTR, although tricuspid valvuloplasty or tricuspid valve replacement solve thetricuspid regurgitation, which neither eliminate the cause, nor change the wholecardiac structure and function, thus the surgical result is unsatisfactory. Cautiousattitude shall be adopted in surgical treatment due to the higher death rate during andfollowing operation.