Severe Tricuspid Insufficiency Secondary To Rheumatic Mitral Stenosis: A Case Report And Review Of The Literature

Objective:Discuss the mechanism of tricuspid regurgitation, summarize the experience of diagnosis and treatment in order to help direct clinical work. Method:Sharing a case who received the operation of mitral valve replacement(MVR) in Fujian province hospital 12 years ago and was diagnosed with severe tricuspid insufficiency 2 years after the operation. Review the relevant literature.And Learn the disease Tricuspid insufficiency in aspect of epidemiology, etiology, pathology, pathophysiology, diagnosis and treatment. Result:Case introduction: a 56-year old female,postoperative MVR for 12 years,tricuspid insufficiency for 10 years.The chief complaint is repeated cardiac insufficiency.The UCG report conducted in Feb 15 showed dilatation of right heart and tricuspid insufficiency(+++~++++).The patient was in hospital for surgical therapies.Before operation,medications such as Vigra were given in order to improve cardiac function and so it did.We checked it with a UCG.Then the tricuspid valvuloplasty was conducted,It was seen in the operation that both the atrias and ventricles were enlarged, the annulus of tricuspid was expanded with tricuspid insufficiency.We take the No. 32 Edward MC to shade the valve ring, the water test evinced nice affect, Trans esophageal echocardiography showed: the tricuspid valve worked well. After operation. Patient got through ICU smoothly, and went back to general ward. Two days later, the patient got shortness of breath, irritability, difficult to cough up sputum, body examination showed good cardiac condition, and the lungs could be heard moist rales and more scattered dry rales. The chest Jicha films showed the lungs Exudation change, Arterial blood gas analysis showed carbon dioxide retention obviously. We gave the patient high-flow nasal cannula oxygen and supplied antispasmodic, asthma, pulmonary artery diastolic strengthen lighten right heart load, B ultrasound-guided pleural puncture and fluid drainage and other treatment. But she did not feel better, and blood gas analysis showed normal oxygenation index, and carbon dioxide retention heavier than before. So We added BIPAP respirator, anti-infective, fogging antispasmodic and other symptomatic and supportive treatments. After these, the patient's breathing significantly improved, and blood gas analysis showed significant improvement in carbon dioxide retention. Conclusion:Tricuspid regurgitation tricuspid valve is a kind of organic disease or functional tricuspid regurgitation caused by various factors. in patients suffering from tricuspid regurgitation who are in need of treatment, their disease is usually secondary to left heart valve disease. And usually combines with mitral valve disease. Persistent tricuspid regurgitation on right ventricular function may cause irreparable damage, leading to poor prognosis. In surgical treatment, the short-term and long-term effects of tricuspid valve replacement are worse than tricuspid valve plasty, and the implantation of artificial valve ring was significantly better than the suture forming in the long-term effect. The patients with severe tricuspid regurgitation are often suffering from poor cardiac function. They especially need systematic and personalized treatment.