杨静,黎婧怡,荆志成

• 1:中国医学科学院北京协和医学院北京协和医院心内科

摘要(Abstract)：

目的 分析重度肺动脉高压并发自发性三尖瓣腱索断裂患者的临床特点和治疗方法。方法 对北京协和医院收治的2例重度肺动脉高压并发自发性三尖瓣腱索断裂患者的临床资料进行回顾性分析；结合文献中其他3例病例资料，总结该病临床特点，探讨治疗方法。结果 临床表现：5例患者均表现为原有病情急性加重并快速进展，4例出现心原性休克，1例表现为顽固的重度右心功能不全。治疗及转归：1例患者行急诊三尖瓣置换术，术后临床症状缓解；1例患者行房间隔球囊造口术，术后临床症状轻度减轻；1例患者行肺移植术，围术期死亡。临床随访：2例患者分别在发病4周和8个月死于心原性休克和多脏器功能衰竭。结论 自发性三尖瓣腱索断裂是重度肺动脉高压患者的少见并发症，患者病情危重，多进展为心原性休克，预后不佳；部分患者可以通过三尖瓣手术治疗缓解病情；心肺移植可能是此类患者最终的治疗方案，球囊房间隔造口术可以作为一种姑息治疗的方法。

关键词(KeyWords)： 三尖瓣;腱索断裂;肺动脉高压;球囊房间隔造口术

Abstract:

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基金项目(Foundation):

作者(Author): 杨静,黎婧怡,荆志成

参考文献(References)：

• [1] Cheng Y, Yao L, Wu S. Traumatic tricuspid regurgitation[J].Int Heart J,2017,58(3):451-453. DOI:10.1536/ihj.16-266.
• [2] Kanemitsu S, Sakamoto S, Yamamoto N, et al. Valve repair for tricuspid papillary muscle rupture late after percutaneous coronary intervention[J]. Eur J Cardiothorac Surg,2018,54(5):959-961. DOI:10.1093/ejcts/ezy175.
• [3] Braverman AC, Coplen SE, Mudge GH, et al. Ruptured chordae tendineae of the tricuspid valve as a complication of endomyocardial biopsy in heart transplant patients[J]. Am J Cardiol, 1990, 66(1):111-113. DOI:10.1016/0002-9149(90)90748-p.
• [4] Rodrigues AC, Afonso JE, Cordovil A, et al. Spontaneous tricuspid valve chordal rupture in idiopathic pulmonary hypertension[J]. Echocardiography, 2016, 33(3):472-475. DOI:10.1111/echo.13130.
• [5] Winter JL, Castro P, Vega J, et al. Spontaneous rupture of tricuspid valve papillary muscle in pulmonary hypertension secondary to HIV infection. Report of one case[J]. Rev Med Chil, 2014, 142(2):246-249. DOI:10.4067/S0034-98872014000200014.
• [6] Kunhali K, Cherian G, Bakthaviziam A, et al. Rupture of a papillary muscle of the tricuspid valve in primary pulmonary hypertension[J]. Am Heart J, 1980, 99(2):225-229. DOI:10.1016/0002-8703(80)90769-3.
• [7] Chen L, Larsen CM, Le RJ, et al. The prognostic signifi cance of tricuspid valve regurgitation in pulmonary arterial hypertension[J].Clin Respir J, 2018, 12(4):1572-1580. DOI:10.1111/crj.12713.
• [8] Medvedofsky D, Aronson D, Gomberg-Maitland M, et al.Tricuspid regurgitation progression and regression in pulmonary arterial hypertension:implications for right ventricular and tricuspid valve apparatus geometry and patients outcome[J].Eur Heart J Cardiovasc Imaging, 2017, 18(1):86-94.DOI:10.1093/ehjci/jew010.
• [9] Topilsky Y, Khanna A, Le Tourneau T, et al. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension[J]. Circ Cardiovasc I m a g i n g, 2 0 1 2, 5(3):3 1 4-3 2 3. D O I:1 0. 11 6 1/CIRCIMAGING.111.967919.
• [10] Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J].Eur J Cardiothorac Surg, 2021, 60(4):727-800. DOI:10.1093/ejcts/ezab389.
• [11]高强，徐巍，王定宇，等.肺动脉高压介入治疗研究进展[J].中国介入心脏病学杂志，2020,28(16):644-646. DOI:10.3969/j.issn.1004-8812.2020.11.009.