ABSTRACT
Objective:This study assesses the results of the clover technique for the treatment of tricuspid regurgitation(TR) due to severe prolapse or tethering.Methods:From March 2016 to November 2018, 28 patients with severe TR due to prolapsing or tethered or adhesion leaflets underwent clover technique. Annuloplasty was associated in 27 patients(97%). The aetiology of TR was rheumatic in 19 cases(68%), subacute bacterial endocarditis in 4(14%), degenerative in 3(11%) and ischemia of right ventricular(the peacing leads compress the septum leaflet in 1 case) in 2(7%). The main mechanism of TR was prolapse/flail of one leaflet in 7 patients(23%), of two leaflets in 13 patients(46%) and of all three leaflets in 6 patients(21%). The remaining 2 patients(7%) presented with severe leaflets’tethering.Results:None deaths occurred during hospitalisation and one patient dischargedvoluntary 12 days after surgery. Follow-up of the 27 hospital survivors was 100% complete[mean length(1.2±0.8)years, range 0.25-1.70 years]. At the last echocardiogram, no or mild TR was detected in 25 patients(88.7%), moderate(2+ /4+ ) in two(9.6%) and severe(4+ /4+ ) in one patient(3.6%). Mean tricuspid valve area and gradient were(4.3±0.6 )cm 2 and(2.8±1.4)mmHg(1 mmHg=0.133 kPa). There was no obvious valve stenosis in all cases. In all patients, echocardiography was performed and no signs of tricuspid stenosis were detected. At the multivariable analysis, the degree of TR at hospital discharge was identified as the only predictor of TR 2+ at follow-up. Conclusion:Clover procedure is simple and safe in the surgical management of various causes of TR besides severe tethering and calcification, it is an effective supplementary measure for annuloplasty.
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From July 1991 to June 2002,80 patients undergoing 19 mm aorta mechanical prosthetic valve replacement and 80 patients undergoing ≥ 21-mm valve replacement were enrolled. There was a significant difference in left ventricular wall thickness,mass index,and pressure gradients in 19-mm valve replacement (P 0.05). The difference of left ventricular wall thickness,mass index,and pressure gradients was lower in group with effective orifice area index (EOAI) 0.75 cm2/m2 (P 0.05). Patients with 19-mm prosthetic aortic valves can experience a satisfactory improvement and intermediate-term survival. It is important for weight-control after replacement.
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0.05).The proportion of TR degree improved in patients of two groups in a short-term.However,the difference of TR in long-term between two groups was statistically significant(P