风湿性心脏病中三尖瓣疾病的概况

背景

高达8%的三尖瓣狭窄患者源于从风湿性心脏疾病。三尖瓣狭窄在大多数临床检查中不易被发现,除非临床上高度怀疑其存在。未被发现因此未被正确治疗,三尖瓣狭窄可能导致瓣膜病术后低心输出量,尽管左侧瓣膜疾病已有成功救治的经验,但仍有很高的死亡率和发病率。

二维超声心动图(2DE),可以发现增厚的三尖瓣瓣叶和减少的三尖瓣开口直径,连续波形多普勒可用来估计三尖瓣跨瓣压差。

方法

从总计6319名的患者中筛查出381个风湿性心脏病患者。我们在超声实验室前瞻性的分析了381名风湿性心脏病患者。本研究于2010年3月至2011年4月在KLES医院进行。三尖瓣狭窄由超声心动图仔细检查三尖瓣得出。三尖瓣反流由汞金合剂评估。根据ASE指南将三尖瓣狭窄的程度和反流的程度进行分级。

结果

在381名患者中,70人(18.3%)为器质性三尖瓣疾病。31人为三尖瓣狭窄合并反流(8.4%-6男性,25名女性),有器质性三尖瓣反流的为38人(9.9%-19男性,19名女性)。在这些有器质性三尖瓣疾病的患者中包括60名合并二尖瓣瓣膜疾病。二尖瓣疾病患者中还包括247名二尖瓣和主动脉瓣联合瓣膜病变57人(20%),而二尖瓣、主动脉瓣和三尖瓣联合瓣膜病变为10人(2.6%)。没有孤立性的三尖瓣狭窄病例。孤立性的风湿性三尖瓣狭窄很少见,几乎没有孤立出现,通常合并二尖瓣瓣膜病变。

结论

风湿性三尖瓣疾病在风湿性心脏病患者中很常见,但因为不太引人注意而容易被忽略。手术行慢性风湿性二尖瓣和主动脉瓣病变前用超声检查联合瓣膜病变就显得尤其重要。尽管对左侧瓣膜手术成功,但残留的三尖瓣狭窄仍可导致术后的低心输出量。在这里,心超在早期检测风心病左右侧瓣膜中扮演了非常重要的角色。因此,心超应该被推荐作为风心病检查的常规手段,以及在随访中及时指导对严重瓣膜病变的干预。
英文原文:

Background

Upto 8% patients of Tricuspid valve stenosis stems from Reumatic heart disease. Alas, Tricuspid valve Stenosis deceives most clinical examination and remains covert except in advanced cases where a striking degree of clinical suspicion exists. Undetected and thus uncorrected , Tricuspid valve stenosis may lead to postoperative low cardiac output notwithstanding  successful relief of left-sided valve disease and exhibits a high mortality and morbidity.

Two-dimensional echocardiography (2DE) can uncover thickened Tricuspid valve leaflets and a reduced Tricuspid valve orifice diameter, and continuous-wave Doppler allows estimation of the Tricuspid transvalvular pressure gradient.

Methods

A total of 6319 patients were screened out of which 381 had rheumatic heart disease. We prospectively analysed 381 patients afflicted by Rheumatic heart disease in our echo lab. The study was regulated from March 2010 to April 2011 at KLES Hospital, Belgaum, Karnataka. Tricuspid valve was scrutinized by echocardiography for Tricuspid stenosis  , Tricuspid regurgitation and amalgam of twin. The severity of Tricuspid stenosis and regurgitation was graded according to the ASE guidelines.

Results

Among those 381 patients, 70 patients (18.3%) encompassed Organic Tricuspid valve disease. Patients with combined Tricuspid stenosis and regurgitation were 31 (8.4%-6 males, 25 females), and with organic Tricuspid regurgitation were 38 (9.9%-19males, 19 females). Among those with organic Tricuspid valve involvement 60 patients (90%) were with concomitant Mitral valve disease. Patients with Mitral valve  involvement were 247 (65%)combined Mitral and Aortic valve involvement were 57 patients (20%) and those with concoction of Mitral, Aortic and Tricuspid valve involvement were 10 patients (2.6%) . There were no cases of isolated Tricuspid stenosis. Isolated  rheumatic  TS  is  uncommon  and  almost never occurs  as  an  isolated  lesion  but  generally  accompanies  mitral  valve disease.

Conclusions

Rheumatic  Tricuspid  valve  disease is common  among  patients  with rheumatic heart  disease,  but  attracts  less  attention  and  might, therefore, be overlooked. The  detection  of  concomitant  tricuspid stenosis  is  considered  to  be  particularly  important  during surgery  for  chronic  rheumatic  mitral and  aortic  valve  lesions. Residual  tricuspid  stenosis,  despite  successful surgical relief  of  left-sided  disease,  is  believed  to  result  in  a low postoperative  cardiac  output.  Here, echocardiography  plays  an  important role  in  early  detection of  RHD  involving  both  left and  right  sided  valves. Therefore, echocardiography  should  be  recommended  as  a  routine screening  tool  for  investigation  of  RHD,  and  also for  follow  up  to  guide in the  timely  intervention  for  severe  valvular  lesions.



    2012/3/30 13:17:05     访问数:632
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