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中华心脏与心律电子杂志 ›› 2025, Vol. 13 ›› Issue (04) : 193 -203. doi: 10.3877/cma.j.issn.2095-6568.2025.04.001

标准与规范

经导管三尖瓣环成形术中国专家共识(试行版)
中国医师协会心血管内科医师分会结构性心脏病学组 国家放射与治疗临床医学研究中心 苏州工业园区东方华夏心血管健康研究院   
  • 收稿日期:2025-09-01 出版日期:2025-12-25

Chinese expert consensus on transcatheter tricuspid valve annuloplasty ( pilot version) Structural Heart Disease Group, Chinese College of Cardiovascular Physician, National Clinical Research Center for Interventional Medicine, China Heart House Corresponding authors:Zhou Daxin, Email:zhou.daxin@zs-hospital.sh.cn; Wu Yongjian Email: yongjianwu_nccd@163.com; Ge Junbo, Email:jbge@zs-hospital.sh.cn

Structural Heart Disease Group, Chinese College of Cardiovascular Physician, National Clinical Research Center for Interventional Medicine, China Heart House   

  • Received:2025-09-01 Published:2025-12-25
引用本文:

中国医师协会心血管内科医师分会结构性心脏病学组 国家放射与治疗临床医学研究中心 苏州工业园区东方华夏心血管健康研究院. 经导管三尖瓣环成形术中国专家共识(试行版)[J/OL]. 中华心脏与心律电子杂志, 2025, 13(04): 193-203.

Structural Heart Disease Group, Chinese College of Cardiovascular Physician, National Clinical Research Center for Interventional Medicine, China Heart House. Chinese expert consensus on transcatheter tricuspid valve annuloplasty ( pilot version) Structural Heart Disease Group, Chinese College of Cardiovascular Physician, National Clinical Research Center for Interventional Medicine, China Heart House Corresponding authors:Zhou Daxin, Email:zhou.daxin@zs-hospital.sh.cn; Wu Yongjian Email: yongjianwu_nccd@163.com; Ge Junbo, Email:jbge@zs-hospital.sh.cn[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2025, 13(04): 193-203.

三尖瓣反流(TR)是常见的瓣膜性心脏病之一,严重的 TR 与患者不良预后相关。近年来,多项经导管三尖瓣介入治疗(TTVI)技术,尤其是经导管三尖瓣环成形(TTVA)技术取得重大突破。为了促进 TTVA 技术在我国安全规范、健康地发展,本共识从技术背景、团队构成与临床评估、影像学评估、手术流程、并发症防治、术后用药、随访等方面详细介绍了 TTVA 技术,并提炼梳理了 10 个核心观点,有利于读者迅速掌握共识的精髓要点。

图1 经导管三尖瓣环夹合成形系统(TTVAC)结构示意图
图2 术前 TTE 评估(2A为心尖四腔心切面,显示左、右心房明显增大及右心室轻度增大,房性功能性 TR,对合高度降低,三尖瓣关闭见缝隙;2B为胸骨旁右心流入道切面,显示右房室增大,室性功能性 TR,瓣叶栓系,三尖瓣关闭见较大缝隙;2C为心尖四腔心切面,彩色多普勒显示重度 TR;2D为胸骨旁右心流入道切面,彩色多普勒显示重度 TR;2E为剑突下三尖瓣短轴切面显示三尖瓣为正常的三叶瓣;2F为剑突下三尖瓣短轴切面显示三尖瓣为异常的四叶瓣,其中后叶分为二叶;2G为根据 PISA 法估测EROA 及 RVol)注:TTE为经胸超声心动图,TR为三尖瓣反流,PISA为近端等速表面积,EROA为有效反流口面积,RVol为反流容积
图3 术前 TEE 评估[3A为食管中段四腔心切面,显示双心房明显增大,三尖瓣关闭见缝隙;3B为根据食管中段聚焦三尖瓣环全容积显像定量评估三尖瓣环左右径、前后径、面积及周长;3C为三尖瓣三维外科视野,清晰显示前叶、后叶及隔叶,并见巨大关闭缝隙;3D为食管中段四腔心切面,彩色多普勒显示重度 TR;3E为食管中段 X-Plane 双切面(食管中段大血管短轴切面及食管中段反四腔心切面),彩色多普勒显示重度 TR;3F为三尖瓣三维外科视野,彩色多普勒显示三尖瓣中央区重度TR]注:TEE为经食管超声心动图,TR为三尖瓣反流
图4 三尖瓣与冠状动脉位置评估(4A为冠状面;4B为矢状面;4C为二维斜位重建;4D为三维重建)注:Ao为主动脉,TVA为三尖瓣环,RCA为右冠状动脉
图5 着陆区与锚定点(5A. 着陆区;5B. 锚定点)
图6 经导管三尖瓣环夹合成形系统(TTVAC)超声引导下手术流程
图7 经导管三尖瓣环夹合成形系统(TTVAC)透视引导下手术流程
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