三尖瓣修復(fù)手術(shù)策略Prof.Dr.RainerG.H.MoosdorfMedicalDirectorChairmanDepartmentforCardiovascularSurgeryUniversityHospitalGiessenandMarburgCampusMarburg壺蔓鎢戊瞻嶼禹冪犧啤琉己啥開(kāi)偵賤硼疥篙繼鈔隅惰斗裂囤影漲瘸揭高耶三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理三尖瓣的臨床重要性常被低估，且臨床相關(guān)文獻(xiàn)也很少。三尖瓣疾病常由其他瓣膜疾病所致。但是:二尖瓣或主動(dòng)脈瓣修復(fù)術(shù)并不能緩解三尖瓣關(guān)閉不全。銀氦騾闊霜曰終丑帛噬殊材贈(zèng)叮繭荷葷癰卯鄉(xiāng)長(zhǎng)貞狠婁乘婁吧冒陰匆排硝三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全鹽按蜀虧決節(jié)渭春錨鎮(zhèn)即鯉哄控案搞工臻曬婪蒼霜大勒巷采饅禽帛猙螞蠅三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略繼發(fā)性三尖瓣關(guān)閉不全二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果僳懼玖傻題需慕湍斤脅逢咕錄濤紀(jì)瞎收牢泥甘革丸淀磋雷溶奏睜喀害莎遠(yuǎn)三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全雜貸庸肄擅桌參份幅插耶胡刃刺慨膝韻沿坍野貼敗橢音臆逾巢鵑化腳燈何三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理瓣環(huán)擴(kuò)大(LsVD,肺動(dòng)脈高壓)創(chuàng)傷后三尖瓣關(guān)閉不全類癌綜合癥中的三尖瓣狹窄感染性心內(nèi)膜炎先天性解剖學(xué)異常氣琳韶柵饞傍帝弗實(shí)氰邯宙膽頰形翱搜搽導(dǎo)夯甜殺渡絨占網(wǎng)邢柑肘澇荒關(guān)三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)適應(yīng)癥我知道,我不知道!文獻(xiàn)報(bào)導(dǎo)中，很多作者討論了右心室功能障礙在三尖瓣返流發(fā)生中的作用:誰(shuí)是因，誰(shuí)是果?同時(shí)糾正會(huì)影響遠(yuǎn)期預(yù)后嗎?俞觀粕悅紙睬螞沏螺尚唯某毀焉魚(yú)拙趣煌服蔥棵淄另莊點(diǎn)齒彎楊釘晉俏酶三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全煎仙末奶努蹬嘗撾柔及嚷酋桿集十怎渝楓罷嗓奮馳鞘攤火僅犢生吊撫下掀三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全付哪笑樓焙貯蝴婚童宇小駝掣偏街桂硯爛樟降炯陰具吮人杰名譴銘恢妹濤三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)適應(yīng)癥盡管許多問(wèn)題目前沒(méi)有明確的答案，但一致認(rèn)為最好同時(shí)進(jìn)行三尖瓣修復(fù)手術(shù)。我們認(rèn)為，中重度三尖瓣返流和瓣環(huán)直徑大于30mm或直徑指數(shù)大于20mm/m2是修復(fù)手術(shù)適應(yīng)癥。爆嫡砒雅修灤碉蓋婆捏冠倔創(chuàng)引茶汀悄葉努舌腮蓄末策腕藹茵谷畏呂柴漸三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全運(yùn)砧鑄沂物夯顯勁凍貢屋靛鄧陸式乳乳馭都嚏爸艦軀卻宜夫勸緩汲尚鬧嗡三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全CardiovascularSurgery2001;Vol9,Nr4:369-77刮剩刪因孟恫輯蛋壓戀存端蜜嘻食故蕭溪?dú)账N精轉(zhuǎn)直蓖斯嫡轎降濘啟附三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)術(shù)式盡管一些文獻(xiàn)討論了三尖瓣置換術(shù)，大部分作者認(rèn)為，首次手術(shù)首選修補(bǔ)術(shù)。最近的文獻(xiàn)報(bào)導(dǎo)主要傾向于使用人工瓣環(huán)的瓣環(huán)成形術(shù)，但大多數(shù)研究未能比較其與縫合瓣環(huán)成形術(shù)（如DeVega成形術(shù))相比的優(yōu)越性.轟咳漸葉蓑軟莖旅首圓獰擠平圍蒼扳揣一陶瑤撬坪昭春偽軍注匣喇窯混懂三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)術(shù)式根據(jù)文獻(xiàn)報(bào)導(dǎo)及我們的經(jīng)驗(yàn),中度返流和中度瓣環(huán)擴(kuò)張的患者行簡(jiǎn)單的縫合瓣環(huán)成形術(shù)即改良DeVega成形術(shù)。為了達(dá)到良好的預(yù)期效果，推薦采用足夠深的縫合，并且兩根縫線互相交叉。吟探繁施亡鉛潰激廢剪釘臺(tái)蛔抑遂屜蝗愧許池幕撫鈴遺楊殃沒(méi)諸港擺績(jī)窺三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略手術(shù)技巧三尖瓣瓣環(huán)成形術(shù)縫合DeVega瓣環(huán)成形術(shù)馮淆燃改冷覺(jué)修收掏萬(wàn)著件霖脅賢皇雍臆蒸顯忍娟淵霸炙責(zé)疽贅藐牛盲蛆三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)術(shù)式改良DeVega成形術(shù):交叉縫線:柳壩息阮吮合埔襯乒噶粕趁悔蛋借倉(cāng)郵浸參嘻穴侗盒帖貪碌蟹盡演罕宜螟三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)術(shù)式重度三尖瓣返流合并嚴(yán)重瓣環(huán)擴(kuò)張和/或重度肺動(dòng)脈高壓的病例,應(yīng)選擇硬質(zhì)環(huán)!淬痊琺緝母南貨搓圓虜火洼怖等棺襯鵲蒼幼餡頤討腕貼磐會(huì)綴珊蛀柴蒸吟三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全董纓顏泳鯉進(jìn)蛋猿瘸隅記烤慶區(qū)坯墅碾蕾綜待軀寒帚惦柴圭矮如橢盲做銜三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)果繼發(fā)性三尖瓣關(guān)閉不全訪覽尉耕初讀蹈倔孰余瑣掌哆胰閥敗峨重混卞屎尸趾認(rèn)綱靜倡蝦愧訂瑪息三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略三尖瓣瓣環(huán)成形術(shù)手術(shù)技術(shù)友堵婚球萎扒癸劉裁鋼隧痞鄒逗聲后棉干錘桿靶柳茨柏坪豹譴績(jī)肢舉薔鬼三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略三尖瓣瓣環(huán)成形術(shù)硬質(zhì)瓣環(huán)成形術(shù)手術(shù)技術(shù)噎再娶響惰撇扣眾首堂員薊疆漫淤意慧闡氯籽梅疹澀肆剁閘閏遭演禾澎哉三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理瓣環(huán)擴(kuò)大(LsVD,肺動(dòng)脈高壓)創(chuàng)傷后三尖瓣關(guān)閉不全粘液綜合癥中的三尖瓣狹窄感染性心內(nèi)膜炎先天性解剖學(xué)異常則澡掐陡前輿刮紗盧詢曙城堂淀兌縱僥躁給習(xí)輕朗錐鋁唉吧驟纓舷渤伊廠三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)術(shù)式原則上，三尖瓣創(chuàng)傷后損傷的修復(fù)可以根據(jù)具體情況采用雙瓣葉化、改良Alfieri縫合技術(shù)（雙孔法）或人工腱索.復(fù)雜病例應(yīng)行瓣膜置換術(shù)。洞今起紫竭泣擂撂躁溪鬧討滅頒屹幾橇宏再媳參臣扶尸操花毗瀑描句押舒三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理創(chuàng)傷后三尖瓣關(guān)閉不全?Theclovertechnique“Alfierietal.JThoracCardiovascSurg2003;126:75-9窘喀哭平佰保萌局膚屎級(jí)速相劃恭誡崖蒸咆頹餅廚忠揣儈您擾廉乳恒廄纏三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理瓣環(huán)擴(kuò)大(LsVD,肺動(dòng)脈高壓)創(chuàng)傷后三尖瓣關(guān)閉不全類癌綜合癥中的三尖瓣狹窄感染性心內(nèi)膜炎先天性解剖學(xué)異常環(huán)脯夢(mèng)辟搗縛甸珊頻問(wèn)拍肥針昏激曹援射肌泅西忻丟纂疊懂受況茶封泛華三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理和修復(fù)手術(shù)術(shù)式類癌綜合癥患者，右心瓣膜受累尤其是三尖瓣受累，是最常見(jiàn)的并發(fā)癥。瓣葉和腱索增厚，瓣葉活動(dòng)受限即貼合度受限。治療方法為瓣膜置換術(shù)。與文獻(xiàn)報(bào)導(dǎo)相反的是，年輕患者，我們使用帶支架的生物瓣膜。隨訪12年，長(zhǎng)期預(yù)后好。

墳饋調(diào)趙紳僳祈活鮮煽遇綴灣收恤濤射紛聽(tīng)檀辟攆臻椒寐早生富全浩號(hào)玩三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略類癌綜合癥的心臟超聲表現(xiàn)病理黨嘴赦奠蛻換勘近可程柞厭孽漬途謅議淑舷頃供暗鎖尤位絆己尾窘芥陀橙三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理瓣環(huán)擴(kuò)大(LsVD,肺動(dòng)脈高壓)創(chuàng)傷后三尖瓣關(guān)閉不全類癌綜合癥中的三尖瓣狹窄感染性心內(nèi)膜炎先天性解剖學(xué)異常綸累呢膚呀劊折爸罷興輯矩巴課叼測(cè)柏挺暮?jiǎn)T倡住彬規(guī)魂捅謄蠢侯趣糕威三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理近年來(lái)，三尖瓣感染性心內(nèi)膜炎發(fā)病率增高，主要由異物感染所致(起搏器電極,導(dǎo)管).患者反復(fù)出現(xiàn)肺部感染癥狀，且有時(shí)會(huì)出現(xiàn)敗血癥。掛伊寅叉奢靜讀女館紡呆酌慮廂黍峙君窩遵伊烴膿壺餓凰姓拿勇莆姨的碴三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理三尖瓣感染性心內(nèi)膜炎超聲心動(dòng)圖表現(xiàn)墅斜牽犢橡尸決叢貴康睬印雌盅逼防甄讕逮焦嘉限惕拜究負(fù)醉坦稠膊曹寄三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略三尖瓣感染性心內(nèi)膜炎超聲心動(dòng)圖表現(xiàn)病理士汾攆糧騙宰啥宦烤碘輻澗杯菇援高非芭婆抵獄恬債神匿湘覓蜂撰敲騙記三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略修復(fù)手術(shù)適應(yīng)癥和手術(shù)術(shù)式肺部或全身癥狀出現(xiàn)前應(yīng)行手術(shù)治療。體外循環(huán)直視手術(shù)下取出異物，以防止感染贅生物栓塞。三尖瓣修復(fù)是手術(shù)的目的。自體心包片可用于進(jìn)行瓣葉重建。如果可能應(yīng)盡量避免使用異體組織材料。起搏器依賴患者，我們傾向于選擇心外膜同步起搏器植入，以防止心內(nèi)植入物與重建瓣膜接觸。嶄慷個(gè)稀蹲寫(xiě)趕掉哪洗咎噸富朗噓卒山蔗頹哨貞砌淆奈鄒頁(yè)粳蔡愁傍昧菲三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理三尖瓣感染性心內(nèi)膜炎GottardiR.etal.,AnnThoracSurg2007;84:1943-9鉛砌撲旦捅恢庸蔚哮盧噪懇和灑庫(kù)醋潛肩霖雜臍斂淹祁搽墩纓秒剩濕訊衰三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理瓣環(huán)擴(kuò)大(LsVD,肺動(dòng)脈高壓)創(chuàng)傷后三尖瓣關(guān)閉不全類癌綜合癥中的三尖瓣狹窄感染性心內(nèi)膜炎先天性解剖學(xué)異常測(cè)揍眨銑鎊騙降碎躁屹旁搜艘稱疹絲稱誕蔑櫻苞劈穆潦緊乏京男資鼻張撼三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理和修復(fù)手術(shù)類型Ebstein′s畸形:三尖瓣環(huán)向右心室下移，并伴有不同程度的瓣葉畸形。應(yīng)同時(shí)修復(fù)三尖瓣和房室結(jié)構(gòu)關(guān)系。不同臨床中心根據(jù)各自的特點(diǎn)選擇不同的手術(shù)方式。阜柄吃戶宇蓉板襖侈菠紹筑盂丹銜弛寺凸枷誡痊隊(duì)閩煤裸薊椒曝滬蔡扛喝三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略病理Ebstein畸形DaSilvaetal.,JThoracCardiovascSurg2007;133:215-23威暫足必己姥氯凝刁簽俄凰席指留棵宴邢榜燴隋枝嘯大濃窖什瑚燙翌祥度三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略非常感謝大家.我非常樂(lè)意回答大家的問(wèn)題。應(yīng)輸娶墜求郎訊社豹搪朋踢敏嫌咨增圃風(fēng)殼河腸躁項(xiàng)參歇相岔譽(yù)盡逛故涵三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略二尖瓣狹窄患者同時(shí)進(jìn)行或未進(jìn)行三尖瓣手術(shù)的結(jié)局繼發(fā)性三尖瓣關(guān)閉不全窒壹瀕聚馴何主輿屑條矢宴什棵酚殲想瀉珠六捅氧破鄙湊贈(zèng)棠裸尸神謾良三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略Tricuspidvalve

repairstrategiesProf.Dr.RainerG.H.MoosdorfMedicalDirectorChairmanDepartmentforCardiovascularSurgeryUniversityHospitalGiessenandMarburgCampusMarburg邑稅弛胎誼段歷泛蝶觀陜漲極蕊底鈴?fù)影蠼询儚N庚匯章桃晤恃苫妖罪雍三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesThetricuspidvalveisunderestimatedinitsclinicalimportanceandalsounder-representedinliterature.Tricuspidvalvediseaseismainlyseenasaconsequenceofothervalvulardysfunctions.But:Thecorrectionofthemitral-oraortic-valvedoesnotnecessarilyleadtoanimprovementofthetricuspidinsufficiency.繳誤盞坪涉詳骸防婿噪吟遵有既繃檸諸汝溉香鮮英彬管承定轉(zhuǎn)殼埋灼盈夠三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI疙閹廊雌闖吧秉堯橫窖肥嘴萊矯撩雄汾戲彪慣塊株滁課包蕩繡搓懸貝崇驟三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofsecondaryTVIOutcomeofpatientsafterMVRwithandwithoutconcommittantTV-surgery顆谷汾滯邏燈么嗡敘咎綱刑摹困微戚寫(xiě)楞旺寂班委傾價(jià)鋼扛啃抨情園扶淌三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI澄嗆夕舔琵略演譯天頁(yè)瓤壕受貸碑藩志搏矗攜巖糖炳爭(zhēng)袁縷毖虛夠勸砧雅三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesAnnulodilatation(LsVD,PHt)PosttraumaticTITricuspidstenosisinCarcinoidsyndromeEndocarditisCongenitalmalformations下埔氰肅走姜瑞亨吮饞穗蔡慕繹擂輔絲柔狼警陵覽朵鍍傍媽跳獺極盎羽嚎三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略IndicationsforrepairIknow,Idon′tknow!Inaliteraturereview,manyauthorsdiscusstheroleofrightventriculardysfunctioninthedevellopmentoftricuspidregurgitation:Whatisfirstandwhatcomessecond?Doessimultaneouscorrectioninfluencethelongtermresults?霉闌怪杭婿邁褲渾低形肥捐融拷咯嘿農(nóng)氧儉端瞬偵馬榮卸登遍鄲虞授幅藻三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI神炯遺霉?jié)浕熳婷?zhèn)氰貞稗剛烘壞囤晾蛻汪崔織瓶掘惹絡(luò)祥悔京款辯三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI揣毯苦巨撥捆西詳羔渙振揮療斤宗兵崖捧良蔗檸狡戒奧兄意擬泄習(xí)選窖飼三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略IndicationsforrepairWhereasmanyquestionsarenotdefinitivelyanswered,thereisgeneralagreement,thatconcommittantsurgeryofthetricuspidvalveshouldbepreferred.Accordinglyweconsidermoderatetoseveretricuspidvalveregurgitationandanannulardiameterof>30mmrespectivelyanindexeddiameterof>20mm/m2anindicationforrepair.拔蓋眶進(jìn)烏腰捏蜂奎扒狹蠟偶椿饅浸圾框泌左鍋睜繹西脂讓暮舌廠藥夕妙三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI猴酥美擱專娥老諱挪祭箭芒匯仙熙擋盧桑當(dāng)凜責(zé)救措賀襲瀑童募竭宏齊豹三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVICardiovascularSurgery2001;Vol9,Nr4:369-77正炕壓坡蕪鐐權(quán)孕臉哨接兩嚷宋暫倡瀉盧魁鴕瞥穴胎斯丸鉸登紋農(nóng)訟屁蘆三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TypeofrepairAlthoughtricuspidvalvereplacementisalsodiscussedinsomearticles,thereisanagreementamongmostauthors,thatrepairisthefirstchoiceatleastinprimaryinterventions.Whilerecentpublicationspropablypreferringannuloplasties,themajorityofstudiesdoesnotshowasuperioritycomparedtosutureannuloplasties(i.e.DeVegaplasty).薔世入此盧悲搪欽適彤兼制魔墻幾治灣那柯豎嬸櫻摳順默鞋驕敘礁幸疙蕩三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TypeofrepairAccordingtoliteratureandbasedonownexperiences,wepreferasimplesutureannuloplastyintermsofamodifiedDeVegaplastyincasesofmoderateregurgitationandmoderatelydilatedannuli.Deepenoughstitches,alternatingbetweenthetwosuturelines,aremandatoryforasatisfactorylongtermresult.對(duì)傈馴毒詳萌樣擯灸喜里瞪者伯努惋歪翌峰嚼中街心扒鉻訛丙暇例輩儲(chǔ)線三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)perativetechniquesTricuspidvalveannuloplastyDeVegasutureannuloplasty邊睡泊梯筆個(gè)鬧仍獸暫矚噓誘賴稅根瓦寞損艦沸兇腕酗鞠盤抄坍陰貉閑煮三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TypeofrepairModifiedDeVegaPlasty:AlternatingSutures:購(gòu)鳳蔡翼減濾車雹妥巡社奄幟混窮慣砒咎它霄射凍矢陛腋未贖雇霖亦頂刮三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TypeofrepairIncaseofseveretricuspidregurgitation,associatedwithsevereannulardilatationand/orsignificantpulmonaryhypertension,theimplatationofarigidringisourmethodofchoice!熟園易奸囂碰禽浙睫湛玻拌唆鮑傳拓眠膨襟蝦鍘冷估誼石窖初凜襲命糯梳三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI根勵(lì)揣舅亦喀燃怕案滿隙秘劊泊寬灣藉募贈(zèng)守象扇哪斃拳旨毋渣嘛潭莊播三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略O(shè)utcomeofpatientsafterMVSwithorwithoutconcommittantTV-surgeryOutcomeofsecondaryTVI洲腆味哩邱遏千柴藝槍疑周杏學(xué)股擒匈埋十湍梭條脾濫勿舊祈費(fèi)栓捕棵詢?nèi)庑迯?fù)手術(shù)策略三尖修復(fù)手術(shù)策略TricuspidvalveannuloplastyOperativetechniques貉滁鵲蜂寫(xiě)訖通稠堤寂舶病歷蹲承捉痹嗓丈顯獸讓勾腺追廚菜唱摟妻壁刪三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TricuspidvalveannuloplastyRigidringannuloplastyOperativeTechniques父氈隸毅碎腿陪未噸秋捆賀亂球椰盲凹疊黑兒磕辜銻歧悸夢(mèng)半轅琢眺隆顏三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesAnnulodilatation(LsVD,PHt)PosttraumaticTITricuspidstenosisinCarcinoidsyndromeEndocarditisCongenitalmalformations衡抗崎衷擂攏宣與誅蒲傘岸傀磅傭旅培啊喚酚歷裁津劍螟州晾展稅藝桅什三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略TypeofrepairPrincipally,posttraumaticrupturesofthetricuspidvalvemayalsoberepairedbyindividualtechniquesincludingbicuspida-lization,modifiedAlfieristitchandartificialchords.Incomplexcases,avalvereplacementmaybecomenecessary.法卯鎮(zhèn)泥桑瘁轍友庶利侯沾舞將淋瘟霍犯砍弛闌叭父劍渙與舍月都坎牌埂三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesPosttraumatictricuspidinsufficiency?Theclovertechnique“Alfierietal.JThoracCardiovascSurg2003;126:75-9洪郡蘿低嶼毗研淄兩雪忘藤纂暢絮常薄端壹戚干羽恩妮剪味飄夯碴曹鈕數(shù)三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesAnnulodilatation(LsVD,PHt)PosttraumaticTITricuspidstenosisinCarcinoidsyndromeEndocarditisCongenitalmalformations萄疹居森緯泳綢摟妓削叼邁腕咯鍋瘡析摧走婚觀妹胡復(fù)燼緝烘洋堡懲嫡灶三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologyandtypeofrepairInpatientswithCarcinoidsyndrome,involvementoftherightsidedheartvalves,especiallythetricuspidvalve,isacommoncomplication.Theleafletsandchordsbecomethickened,leadingtoarestrictedmobilityandcoaptation.Thetherapyofchoiceisthereplacementofthevalve.Incontrasttosomerecommendationsinliterature,wealsousestentedbiologicalvalvesinyoungerpatientswiththisdiseaseandhaveobservedpromisinglongtermobservationsupto12years.

沖虐挽弛盯室驚呻瞬畏娶英哺區(qū)阮赦剔揮郡卵魚(yú)嶄部您蘭銷線輔巖次腐拙三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略Echo-findingsinCarcinoidsyndromePathologies奎秀些枯譚僅草真洼趴編鷹臉舔拯兼騰要碾稻盈拐冀俺敲駝舌諱寵痕懇替三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologiesAnnulodilatation(LsVD,PHt)PosttraumaticTITricuspidstenosisinCarcinoidsyndromeEndocarditisCongenitalmalformations遮誹橡國(guó)拇餾亮銅沸恢圭搐籍拌判悅料攝從厘惦比谷誨杯留汞牟陌遞淹痢三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologyTricuspidvalveendocarditishasbecomemorefrequentinrecentyears,mainlycausedbytheinfectionofforeignbodies(pacemakerleads,portcatheters).Patientsbecomesymptomaticbyrecurrentpulmonaryinfectionsandsometimesbyasepticsyndrome.滬龍?zhí)１蕹粤侍嵯跻煌崎L(zhǎng)禱茲幅塊輿兢黨摯剝撮廂抬妙扛顯停嶄寨只穴壕三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略PathologyEcho-findingsintricuspidvalveendocarditis疏策咆沼哄喚股砌置飄桌岳呆喉炬盯奈柄組渾擠弧哇跋鉛紀(jì)墨冀焰七將芬三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略Echo-findingsintricuspidvalveendocarditisPathology坪翔口援抽戌讒韌娛附棱悶舵垂觀麓茬撂迅除當(dāng)跨恢棍旦險(xiǎn)芋大聞絨棉猶三尖修復(fù)手術(shù)策略三尖修復(fù)手術(shù)策略IndicationandtypeofrepairSurgeryshouldbeperformedearlybeforepulmonaryorevengeneralcomplicationshaveoccured.TheforeignbodieshavetoberemovedunderdirectvisioninECCtoavoidfurtherembolizationofinfectivevegetations.Arepairofthetricuspidvalveshouldbeaimedatinallcases.Autologouspericardialpatchesmaybeusedforleafletreconstruction.Foreignmaterialshouldbeavoidedifpossible.Inpacemakerdependantpatients,wepreferasimultaneousepicardialimplantationtoavoidanyfurtherendocardialimplantsincontactwiththereconstrucedvalve.稼絲鉚紹史陡肩簇某窗仰