| Objective: Valvular heart disease is one of the highest cardiovascular disease. Mitral valve disease as a common valvular disease often combines with Functional tricuspid regurgitation(FTR). That is probably because right ventricle hypertension or pulmonary hypertension increased leading to tricuspid loop enlargement, which caused FTR. The doctors pay attention to this disease because the huge number of patients. According to statistics, approximately 25% patients have mitral valve disease or aortic valve disease, meanwhile with FTR. The ratio raised to 48% reported by doctor Dreyfus in 2005. The number of patients with moderate or severe tricuspid regurgitation is estimated to be 1.6 million according to an outcome of American epidemiological survey. Every year only 8,000 patients received operation treatment, and most of them were treated with mitral or aortic valve operation as well as tricuspid valvuloplasty. However, some of them only received mitral or aortic valve operation without tricuspid valvuloplasty. The reason was probably that the injury of tricuspid valve was mild when the patients checked by echocardiography as the major detection before operation. But after operation, these patiens had moderate or severe tricuspid regurgitation, leading to heart failure. From then on some of them led a poor quality life and the effect of former operation also failed. Such situation had be focused on.Former opinion was that after the treatment of left heart valve operation, tricuspid regurgitation would alleviate. Some preoperative patients with no obvious or mild FTR, after a period of left heart valve surgery, had a progressive aggravation of FTR. The ratio of FTR would be up to 31% after the operation according to a survey abroad. Particularly some patients had FTR in a short time leading to right heart failure. In order to improve it, some patients had to undergo the operation once again. This risk also raised. Therefore, the surgical treatment of FTR secondary to mitral or aortic valve is still one of the difficult problems for cardiovascular surgeons. At present, in the valve disease treatment principle, there is no standard about when undergo the surgery of FTR in the simultaneously operation of left cardiac valve operation. Although most of the surgeons consist that doctors should implement the two operation together, the view is still controversial. In order to further understand the problem, we collected the data of 198 past therapeutic patients with rheumatic valvular disease, conducted retrospective analysis, summarized the experiences, explored a simple, quick indicator, in order to help us to determine when need to implement mitral valve replacement meanwhile with tricuspid annuloplasty.Methods: During the period from 2007 to 2011, we collected 198 cases of patients in cardiac surgical department of Xingtai peoples’ hospital and Beijing Anzhen hospital. Male patients were 116, female patients were 82, age: 45-59 years old. All the patients were divided into two groups, 117 patients were treated with mitral valve replacement and tricuspid annuloplasty, we called TVP positive group, male patients were 63 and female patients were 54. mean average is 52.15±10.50. 81 cases of patients only were only treated with mitral valve replacement, we called TVP negative group. Male patients were 53, female patients were 28, the mean age was 49.50±12.50. The choice of operation was assisted by extracorporeal circulation, tricuspid ring was implanted in the operation of tricuspid annuloplasty. Patients should be detected by echocardiography after one year.Results: In the baseline data and the clinical features, the patients in the two groups have not significant difference(P>0.05). All the patient had mild tricuspid regurgitation before operation, the patients in TVP positive group had moderate or severe tricuspid regurgitation. We compared two groups of cardiovascular data before operation, in TVP positive group, Right Atrial Diameter(RAD) was 5.51±6.12, Right Ventricular Dimension(RVD) was 40.21±3.82, Pulmonary artery pressure(PAP) was 55.12±3.24, TVAD is 42.61±1.53, which was obviously higher than that in TVP negative group. RAD was 37.25±3.11, RVD was 30.75±2.33, PAP was 37.44±5.31, TVAD was 35.63±3.14. The data of two groups had statistical difference(P<0.05). No significant statistical differences were found in Right Ventricular Ejection Fraction(RVEF) between two groups(P>0.05). After one year, no significant differences were found in two groups(P>0.05). Most of the patients had mild tricuspid regurgitation. The operation was sucessful. We compared two groups before and after surgery, in TVP positive group, RAD was 35.51±5.51, RVD was 40.21±3.82, PAP was 40.35±5.81, TVAD was 27.86±2.11. The data decreased significantly compared with preoperation. There was no significant change in TVP negative group(P>0.05).Conclusion:1 It is an effective method of treatment on TR secondary to mitral valve diseases by tricuspid valvuloplasty.2 In our study, we suggest that echocardiography may be used to determine whether conducts tricuspid valvuloplasty under the operation of mitral valve replacement.3 If any of the following situation happens: RAD > 45 mm; RVD >40 mm; PAP >55mm Hg; RVAD>40 mm, we should consider the surgical intervention for FTR during mitral valve replacement. |
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