降低肺动脉压能消除严重的功能性三尖瓣返流吗?来自肺动脉血栓内膜剥脱术的启示

作     者：Sadeghi H.M. Kimura B.J. Raisinghani A. 刘豫 

作者机构：Cardiology Univ. California-S. Diego Med. Ctr. San Diego CA United StatesDr. 

出 版 物：《世界核心医学期刊文摘（心脏病学分册）》 (Digest of the World Core Medical Journals(Cardiology))

年 卷 期：2005年第1卷第1期

页      面：44-45页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：三尖瓣返流 肺动脉血栓 肺动脉压 瓣环成形术 瓣叶脱垂 肺动脉导管 超声心动图 压力降低 持续性 估计值 

摘      要：Objectives Because pulmonary thromboendarterectomy (PTE) can result in an imme diate reduction in pulmonary artery (PA) pressure, we sought to evaluate the eff ect of PTE on severe tricuspid regurgitation (TR) without tricuspid annuloplasty . Background Few data exist regarding the frequency and magnitude of functional TR improvement after reduction in PA pressure. Methods We identified 27 patients with severe TR, defined by a regurgitant index (RI)33%, who underwent PTE. The RI, tricusp id annular diameter (TAD), apical displacement of leaflet coaptation, and estima ted PA systolic pressure were determined on pre-and post-PTE echocardiograms. Patients were stratified based on resolution (RI ≤33%) or persistence (RI 33 %) of severe TR. Results Comparing pre-and post-PTE echocardiography results, severe TR resolved in 19 of 27 (70%) patients. This group had a more effective PA systolic pressure reduction after PTE (49 ±20 mm Hg vs. 32 ±16 mm Hg by ec hocardiography, p=0.075, and 37 ±16 mm Hg vs. 16 ±13 mm Hg by catheter measure ment, p=0.004). No difference was observed in TAD, apical displacement of the tr icuspid valve, or other features compared with the group with persistent severe TR. There was a trend toward longer hospital stays in the group with persistent severe TR (19 ±15 days vs. 14 ±9 days; p=0.55). Conclusions After significant PA pressure reduction by PTE, severe functional TR with a dilated annulus may im prove without annuloplasty despite dilated tricuspid annulus diameters.