Applcation Annuloplasty Treatment Functional Tricuspid Regurgitation Curative Effect Contrastive Research

Background: Tricuspid regurgitation in heart valve disease iscomparatively common, its majority belonging to the functional lesion. In ourcountry, the secondary to rheumatoid left heart valve disease system andcongenital heart disease is the primary cause of occurrence of functionaltricuspid regurgitation. On clinic major clinical manifestations are presented asrepeated episodes of right heart failure symptoms, not enough effect of recentdrug treatment and high rate of long-term complications and fatality rate.Application annuloplasty treatment functional tricuspid regurgitation hasdecades of history，becomes the main treatment method. At present there arethe main clinical application of two kinds of operations: suture annuloplastyand annulus annuloplasty. After years of application on clinica, applicationannuloplasty treatment tricuspid regurgitation surgical indications has becomemore and more perfect，Directed against the preoperative lesions in differentpathophysiological morphology and the long-term postoperative effect, the twokinds of operations have been continuously improving on the basis of originalthe shortage. In the course of tricuspid regurgitation treatment, the grasp ofpreoperative chance, the choice of intraoperative operation method andpostoperative further treatment have important influence on improving theoperative effect.Objective: To summarize application annuloplasty treatment of94casesof functional tricuspid regurgitation clinical experience, contrast the effects ofsuture annuloplasty with that of annulus annuloplasty.Methods: Collecting our department from February2010to September2011application tricuspid annuloplasty cure of94patients.34males and60females. Age6-72years old (42±15.52years). Among them are42cases of rheumatic heart disease,47cases of congenital heart disease and5cases ofleft atrial myxoma. Preoperatively use the application of echocardiography forexamination, on the basis of measurement of tricuspid regurgitation area forevaluation.24cases of mild regurgitation，with reflux area of (2.87±0.89) cm2;39cases of moderate regurgitation，with reflux area of (5.82±1.26) cm2;31cases of severe regurgitation，with reflux area of (12.09±4.7) cm2. Two groupsare divided according to whether the operation use the tricuspid forming ring.Suture annuloplasty group, including Kay and De Vega operations, there are atotal of52cases, with44cases of Kay’s suture annuloplasty and8cases ofDeVega’s suture annuloplasty. Annulus annuloplasty group (Wu Ren sithree-dimensional annuloplasty ring) has a total of42cases. In theintraoperative course, right ventricle water injection test is taken to directlyobserve tricuspid annuloplasty effect. During preoperative and postoperativecourses, examinations are taken respectively through echocardiography，observing right ventricular diameter、left atrial diameter、left ventricularend-diastolic diameter、 tricuspid regurgitation area、 cardiac output andejection fraction. Groups members should make comparative researches withinand among groups respectively and observe the forming effect. Observingindexes by matching control measurement material T test within groups,controls mean difference T test among groups should be used for statisticalanalysis, where P<0.05was considered statistically significant.Results: The patient recovered well after surgery, no deaths in twogroups of patients during perioperative period.3cases of postoperativesecondary thoracotomy to stop bleeding.(1case in suture group,2cases inannulus group). All patients did not show the complications such as the lowcardiac output syndrome and multiple organ failure. The heart function wereobviously improved compared to preoperation, including36cases of cardiacfunction in class I,58cases of cardiac function in class II. Cardiothoracic ratio has reduced compared to preoperation. Postoperative TR symptoms haveobviously improved.In suture group, there are45cases of postoperativetricuspid with mild regurgitation，with reflux area of (2.24±0.91) cm2;7casesof moderate regurgitation，with reflux area of (5.84±1.3) cm2; no severeregurgitation occurs. In annulus group, there are35cases of postoperativetricuspid with mild regurgitation, with reflux area of (1.96±0.81) cm2;6casesof moderate regurgitation, with regurgitation area of (5.09±0.83) cm2;1caseof severe regurgitation, with reflux area of10.2cm2. In the suture group,comparisons between preoperative and postoperative forming effects showsthat right ventricular diameter、left atrial diameter、tricuspid regurgitation area、cardiac output、ejection fraction was statistically significant (P <0.05), leftventricular end-diastolic diameter are of no statistical significance (P>0.05). Inthe annulus group, comparisons between preoperative and postoperativeforming effects shows that right ventricular diameter、left atrial diameter、tricuspid regurgitation area are statistically significant (P <0.01), while leftventricular end-diastolic diameter、cardiac output、 ejection fraction are of nostatistical significance (P>0.05). Comparisons between the two groups afteroperation show that left atrial diameter、left ventricular end-diastolic diameter、tricuspid regurgitation area、ejection fraction are statistically significant (P <0.05)、while right ventricular diameter, cardiac output are of no statisticalsignificance (P>0.05). During preoperation according to reflux area dividedinto mild、moderate、severe degrees,which will be further stratified compared.When preoperative reflux area is mild, the two postoperative groups of TRdegree are of no statistical significance (P>0.05). When preoperative refluxarea is moderate or severe, the two postoperative groups of TR degree wasstatistically significant (P <0.05).68patients are visited and followed-up for3-6months and no later death case was found. Cardiac function abilities have improved during the follow-up period，with45cases of Class-I，21cases ofClass-II and2cases of Class-III.63cases of outpatient service done byechocardiography examination tricuspid regurgitation of processes havedifferent degrees of improvement.5patients(3cases in suture group,2cases inannulus group) tricuspid regurgitation increased after discharged, and2patients came back to hospital again due to acute right ventricular failure,circulatory failure symptoms, and discharged at ease after cardiac，diuretictreatment. The other patients recovered well, without atrioventricular block、paravalvular leakage、bleeding、thrombosis、embolism、endocarditis and othercomplications.Conclusion: During the treatment of left heart valve disease or congenitalmalformations of the heart, the corresponding operations of annularconstriction annuloplasty treatment for functional tricuspid regurgitation hasimportant clinical significance on the improvement of the prognosis effect ofpatient; During preoperative course mild functional tricuspid regurgitation is ofthe same curative effect as the suture annuloplasty and annulus annuloplastymethod. During preoperative course moderate to severe regurgitation, theannulus annuloplasty method is more effective than the suture annuloplastymethod；For the patients whose valve condition is good, with moderate tosevere degrees of tricuspid regurgitation, especially those with pulmonaryhypertension of more than moderate to severe degrees, artificial annulusforming operations should be actively performed.