Clinical Effect Observation Of Surgical Treatment For Functional Tricuspid Insufficiency

Objective: Tricuspid valvuloplasty for functional tricuspid insufficiency secondary to left-sided heart valve disease is performed while surgical treatment of left-sided heart valve disease done at the same time, the purpose of that is to observe if it helps reduce the occurrence of mild,moderate or severe tricuspid regurgitation after surgical treatment of left heart valve disease.Methods: Between January 2013 to January 2014, 410 patients underwent surgical treatment for combined valvular diseases in the Department of Cardiovascular Surgery of The general Hospital of Shenyang military region, 183 patients among them associated with functional tricuspid insufficiency were selected to be included in the observational group with three indications below adapted at least one :tricuspid annulus diameter ≥40mm,moderate to severe tricuspid regurgitation, mild tricuspid regurgitation associated with systolic pulmonary artery pressure ≥ 60 mm Hg(or mean pulmonary artery pressure ≥ 40 mm Hg).Male 77 cases,female 106 cases.Age15~73(53.98±10.54)yrs.Tricuspid annulus diameter 27~52(36.38 ± 5.04) cm; 70 cases of moderate tricuspid regurgitation, 57 cases of severe tricuspid regurgitation and mild tricuspid regurgitation associated with systolic pulmonary artery pressure ≥60mm Hg(or mean pulmonary artery pressure ≥ 40 mm Hg) in 56 cases. Ejection fraction 0.29~0.80(0.60 ± 0.09), cardiothoracic ratio 0.4~0.9(0.63 ± 0.08). Rhythm of atrial fibrillation in134 cases and sinus rhythm in 22 cases, rhythm of atrial flutter in 3 cases, rhythm of atrial premature beats in 4 cases,rhythm of premature ventricular contraction in 3 cases.Artificial ring valvuloplasty is used as the main method of tricuspid valvuloplasty,Kay’s valvuloplasty and De Vega valvuloplasty is used in very few cases.Postoperative regular follow-ups were performed on echocardiography for 3 months and 6 months.Results: 3 patients in all of group died. The other patients survived and recovered well after operation with no significant complications,follow-ups are performed on relevant examinations regularly. Indicators of patients of group before operation and after operation are compared, right ventricular diameter(36.38 ± 5.04) vs(27.60 ± 4.25)mm, and left atrial diameter(56.40 ± 12.34) vs(47.57 ± 10.23) mm, and tricuspid annulus diameter(36.38 ± 5.04) vs(31.09 ± 1.22) mm obviously reduced(P<0.01),ejection fraction(0.60 ± 0.09) vs(0.57 ± 0.08), and cardiothoracic ratio(0.63 ± 0.08) vs(0.61 ± 0.06), tricuspid regurgitation velocity(3.61 ± 3.07) vs(2.44 ± 0.39) m/s,systolic pulmonary artery pressure(58.91 ± 18.21) vs(34.69 ± 8.37) mm Hg obviously reduced,levels of tricuspid regurgitation much decreased(p <0.01), long right atrial diameter(65.27 ± 14.03) vs(65.04 ± 13.86) mm, transverse right atrial diameter(47.45 ± 9.87)vs(47.33 ± 9.75) mm have no significant changes(P>0.05).Conclusion: Tricuspid annulus dilation, moderate or severe tricuspid regurgitation and mild tricuspid regurgitation associated with pulmonary hypertension adapt the indicators of surgery for functional tricuspid insufficiency.Artificial ring valvuloplasty is good for functional tricuspid insufficiency, and it is important to increase the long-term effect after operation.