本页包含以下部分:
什么时候修复或置换肺动脉瓣或三尖瓣是可取的?
如何完成肺动脉瓣或三尖瓣的修复或置换?
这种手术的风险和好处是什么?
典型的复苏包括什么?
什么时候修复或置换肺动脉瓣或三尖瓣是可取的?
修理或更换 pulmonary valve or of the tricuspid valve is far less common than repair or replacement of the aortic and mitral valves, 你的心脏是另外两个瓣膜. 肺动脉瓣的手术有时是单独进行的, but surgery on the tricuspid valve is typically undertaken only in conjunction with surgery on one of the other two valves, most often a repair of the mitral valve.
Both the pulmonary valve and the tricuspid valve are made up of three little flaps of tissue that control the flow of blood from one part of your circulatory system to another; the flaps are also known as leaflets or cusps. (“cusp”一词来自拉丁语，意思是“点”,指的是两个阀门的襟翼都是三角形的事实.)
如果你被诊断为肺动脉瓣或三尖瓣受损, your surgeon will evaluate the specifics of your situation—especially how badly damaged your valve is and how serious your symptoms are. Then it will be possible to weigh the risks of surgery against the risks of managing the disorder with lifestyle changes and medication. In most circumstances, it will be advisable to manage your condition with nonsurgical treatments until it is necessary to perform heart surgery for some other reason. But in rare circumstances, it may be advisable to consider stand-alone surgery on a damaged pulmonary or tricuspid valve.
In either case, 通常最好是修理而不是更换损坏的阀门, 因为修复后的瓣膜通常会改善心脏功能, 更好的抗感染能力, 和更好的长期和短期生存.
你和你的外科医生应该决定手术的时机吗, keep in mind that valve repair and replacement surgery is a particular specialty of our cardiac surgeons. 他们甚至在这些不太常见的瓣膜手术方面有相当多的专业知识.
如何完成肺动脉瓣或三尖瓣的修复或置换?
Your surgeon will first determine whether it will be possible to repair your damaged pulmonary or tricuspid valve, 或者是否必须更换. There are two primary ways of repairing a damaged valve; these procedures are sometimes performed separately and sometimes in combination:
- Annuloplasty involves repairing the ring of tissue to which the flaps are attached (this ring is known as the annulus), 通过附着一个组织环, cloth or metal to it.
- Resection 包括修剪和/或重塑皮瓣本身.
如果需要更换而不是修理阀门, 有两种主要的替换阀门. Factors such as your age and the overall state of your health will affect which kind is most appropriate:
- Mechanical valves are made of very durable artificial materials, such as titanium, carbon, polyester, Dacron or Teflon. They are typically very long-lasting; however, use of a mechanical valve usually requires patients to take blood-thinning medication (often referred to by the brand name of Coumadin) for the rest of their lives.
- Biological valves, 也称为组织瓣膜或生物假体瓣膜, are made of animal tissue, often from a pig or a cow. They do not usually necessitate the use of blood-thinning medication; however, 生物瓣膜通常只能使用10到20年, 因此，将来可能需要进行第二次阀门更换手术.
Because surgery on the pulmonary or tricuspid valve is almost always performed in conjunction with another cardiac procedure, 通常是修复二尖瓣, the requirements of that operation typically determine which surgical approach is best. 心内直视手术是二尖瓣修复最常见的选择, but your surgeon will decide which of the following procedures is most appropriate in your particular situation:
- Open-heart surgery 需要在胸骨中间做一个7到9英寸的切口, or breastbone, 然后分开胸骨，进入心脏. In some cases a less invasive option, involving a slightly smaller sternal incision, is possible. 然后对损坏的阀门进行修理或更换. 在手术过程中有必要让你的心脏停止跳动, so the operation can be performed on a motionless and bloodless field; while your heart is stopped, a device known as a heart-lung bypass machine will take over your heart's function and maintain your circulation.
- Minimally invasive surgery involves making one or two much smaller incisions (typically 2 to 4 inches) in the side of your chest, between your ribs. 然后通过插入一个微型摄像机和一个长, 薄薄的手术器械穿过你的组织到达受损的瓣膜. Minimally invasive surgery also requires the use of a heart-lung bypass machine. 虽然这通常不是阀门维修的首选方法, in circumstances when it is appropriate this approach avoids the need to split the sternum and open the entire chest, so recovery may be faster.
这种手术的风险和好处是什么?
It is important to keep in mind that every medical choice involves a trade-off between risks and benefits—whether it is to undergo surgery, take medication, or even just carefully monitor a condition (an option known as "watchful waiting").
在肺瓣膜或三尖瓣受损手术的情况下, deciding whether surgery is advisable involves balancing the risks involved in any heart surgery against the risk that continuing to manage the disorder with medication and other nonsurgical treatments may result in progressive damage to your heart and circulatory system.
手术的风险很低. Since pulmonary or tricuspid valve surgery is usually undertaken at the same time as another surgical procedure, the overall risks are generally the same as for whatever other procedure is being performed—typically a mitral valve repair, but sometimes a mitral valve replacement or an 主动脉瓣修复或置换.
手术成功的好处是相当可观的. 绝大多数的病人, once they recover, 感觉比手术前好多了, 体验症状的缓解, 并且能够恢复他们想要从事的任何活动. In most cases, successful valve surgery also results in improved survival rates.
典型的复苏包括什么?
一个典型的心脏直视手术需要4到6个小时, in some cases up to 8 hours; patients are then maintained under general anesthesia for an additional 4 to 6 hours. 如果他们的心脏运转良好，没有过多的出血, 他们可以从麻醉中恢复过来，并拔掉呼吸管. Most patients stay in the ICU until midday of the day after their procedure; if they continue to do well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed later that day.
典型的住院时间为4至7天. At that point, 绝大多数病人都能回家, 在探访护士服务的支持下, though about 15% to 20% may need to spend some time in a rehab facility for more extensive rehabilitation. After discharge, patients are advised not to drive for about three weeks and not to lift anything heavier than 5 pounds for about 6 weeks. 超过这个点，他们可以恢复他们想要的任何活动.
病人往往会惊讶于控制疼痛是多么容易. 手术后的第二天, 大多数病人不用静脉注射止痛药物就会感到舒服, taking only oral painkillers, 绝大多数人出院后只服用泰诺或布林.
在需要微创手术的情况下, both the length of the operation and the recovery period are typically shorter.
审查页面:2018年6月26日
编辑:Jock McCullough, MD