Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
000
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fa
jalali
1388
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gregorian
2009
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67
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online
1
fulltext
fa
نتایج اعمال جراحی اندوکاردیت دریچه تریکوسپید: بررسی 67 بیمار
Tricuspid valve endocarditis surgery: results of 67 patients
<p dir="rtl" style="text-align: justify"><b>زمینه و هدف:</b> درمان جراحی اندوکاردیت دریچه تریکوسپید شامل برداشتن دریچه، جایگزینی دریچه و استفاده از روشهای ترمیمی میباشد. هدفمطالعه بررسی نتایج اعمال جراحی اندوکاردیت تریکوسپید میباشد. <br></p><p dir="rtl" style="text-align: justify"><b>روشبررسی:</b> در یک مطالعه گذشتهنگر، 67 بیمار مبتلا به اندوکاردیت عفونی تریکوسپید که طی سالهای 86-1376 به بخش جراحی قلب بیمارستان امام خمینی ارجاع و اندیکاسیون جراحی داشتند وارد شدند. بیماران به سه روش برداشتن دریچه بهتنهایی، جایگزینی دریچه و استفاده از روشهای ترمیمی تحت درمان جراحی قرار گرفتند. پیگیری تمام بیماران از طریق اکوکاردیوگرافی بوده است. <br></p><p dir="rtl" style="text-align: justify"><b>یافتهها:</b> میانگین سن بیماران 35/7±52/25 سال بود و 63/74% بیماران مذکر بودند. ترمیم دریچه بیشترین نوع عملی بود کهصورت گرفته بود (72/56%). عمل مجدد بهصورت اورژانس در هشت بیمار (94/11%) صورت گرفت. موربیدیتی پس از عمل در 36/28% موارد دیده شد و میزان مورتالیتی 51/13% بود. 37 بیمار مراجعه منظم داشتند و پیگیری شدند. در دوران پیگیری اگرچه کسر جهشی EF و قطر انتهای دیاستول بطن راست (EDRVD) و ابعاد بطن راست پساز عمل تغییر معنیداری نسبت به قبل از عمل نشان نمیدادند، ولی فشار شریان ریوی و شدت نارسایی دریچه تریکوسپید پساز عمل کاهش یافته بود. کلاس عملکردی نسبت به قبل از عمل تغییر معنیداری نشان نداد. <br></p><p style="margin-top: 6pt text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><b>نتیجهگیری: </b>با توجه به اپیدمیولوژی خاص مبتلایان اندوکاردیت عفونی با نارسایی دریچه تریکوسپید بهنظر میرسد تعویض دریچه در برخی بیماران بهتر از ترمیم دریچه میباشد که شاید بهدلیل خرابی شدید و فرم پیشرفته تخریب دریچه و عدم امکان ترمیم مفید باشد. <br></p>
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<!--stripped--> <strong>Background:</strong><strong> </strong>Surgical
methods for treatment of tricuspid valve (TV) endocarditis include repair, replacement and partial
or complete exicion. The aim of this study was to assess the results of these
different techniques.<br> <strong>Methods:</strong><strong> </strong>Sixty seven patients were enrolled in this retrospective
study. This study was carried-out between April 1997 and July 2007 in Imam
Khomeini hospital. Decision of methods of choice for surgery was according to
intraoperative findings.<br> <strong>Results:</strong><strong> </strong>The mean age was 25.52±7.35 years and 74.36% were male. The most common bacteria was
Staphylococcus areus (62.30%). Most of patients (74.60%) were IV drug abuser. The most common treatment modality was TV reconstruction
(56.72%) and after that was TV replacement (29.85%) and the last one was complete TV excision (13.43%). Eight
patients (11.94%) needed emergent TV replacement. The morbidity rate was 28.36% and the
mortality rate was 13.51%. Thirty seven patients were followed. In follow-up
period it was shown that postoperative Ejection Fraction (EF) and End-Diastolic Right Ventricle
Diameters (EDRVD) values did not differ from
preoperative values, but Pulmonary Artery (PA) pressure and
Tricuspid Regurgitation (TR) severity were significantly lower compared with
preoperative values. The postoperative function class did not show any changes
compared with peroperative values.<br><strong>Conclusion: </strong> Considering the specific epidemiology of patients with
infective endocarditis, who are suffering from TV regurgitation, in some patients, it would be better
to consider replacement instead of repair. This could be due to sever
deformities and diffuse damage of TV leaflets from infection in our patients.</p>
اندوکاردیت عفونی،دریچه تریکوسپید،درمان جراحی،نتایج
Infective endocarditis,tricuspid valve,surgical treatment,results
341
346
http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-447&slc_lang=fa&sid=1
Radmehr
H
حسن
رادمهر