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1、少见的瓣膜治疗少见的瓣膜治疗: 三尖瓣成形三尖瓣成形 Roy K Greenberg, MD特别声明特别声明研究得到的支持Cook Inc, Boston Scientific, W.L.Gore, Cordis, Vascutek, TerareconConsulting, Intellectual Property, Travel ExpensesCook Inc病例报道病例报道65yo 女性，顽固腹水既往史：左侧乳腺切除，放疗，LUE 淋巴水肿4+ 三尖瓣关闭不全, 缩窄性心包炎 (s/p 胸腔镜检，心包部分切除术)术前超声心动图术前超声心动图瓣膜构造的问题瓣膜构造的问题静脉系统的直径不
2、是固定的肝静脉和下腔静脉瓣之间距离很短左颈内静脉/锁骨下静脉血栓开放压力相对低术中固定到支架移植物术中固定到支架移植物制造反流制造反流标记物标记物压缩及安装压缩及安装植入植入Retrograde flowForward flowRetrograde flowForward flow四维成像四维成像结论结论设计方面的问题封闭，固定和瓣环功能的分别处理对于静脉系统和右心非常关键在不同的静脉直径条件下瓣膜的闭合情况高顺应性系统生理学的优势还不确定，但是在随访中明确没有发现有逆向血流Less Common Valvular Interventions: Tricuspid Valve Repair R
3、oy K Greenberg, MDDisclosureResearch supportCook Inc, Boston Scientific, W.L.Gore, Cordis, Vascutek, TerareconConsulting, Intellectual Property, Travel ExpensesCook IncPatient Presentation65yo female with intractable ascitesPrior left mastectomy, radiation therapy, LUE lymphedema4+ tricuspid regurgi
4、tation, constrictive pericarditis (s/p thoracoscopy with subtotal pericardectomy)Preoperative EchocardiographyValve Construct IssuesNon-fixed diameter of the venous systemShort distance between hepatic veins and eustacian valveThrombosis of the left internal jugular/subclavian veinsComparitively low
5、 opening pressuresIntraoperative Mounting To Scaffold StentgraftCreation of InsufficiencyMarkersPackaging and LoadingImplantationRetrograde flowForward flowRetrograde flowForward flowFour Dimensional ImagingConclusionsDesign issuesSeparation of sealing, fixation, and annular functionCritical for the venous system and right heartValvular competence in the setting of variable venous diameterHigh compliance systemUnsure of physiologic benefit but clear absence of retrograde flow throughout follow-up
