编者按:临床对瓣膜病的防治,通常更关注二尖瓣,而三尖瓣相关疾病相对受到忽视。事实证明,三尖瓣疾病治疗更需主要异质性。美国梅奥诊所Maurice Enriquez Sarano教授在ACC 2015现场介绍了这一话题。
International Circulation: You have chaired a discussion entitled, Tricuspid Valve: “I Get No Respect”. What are the issues involved here?
《国际循环》:据我们所知您主持了题为“三尖瓣:未得到应有重视”的专题讨论,该专题主要探讨了哪些问题?
Dr Sarano: The meaning of the title is that tricuspid valve disease is less frequently operated on than mitral or aortic valve disease. The indications in the guidelines are also much less frequent and the main reason is that we don’t really understand tricuspid disease as much as we do mitral or aortic valve disease. In the session, we discussed the new data on outcomes of tricuspid valve disease that allow us to explore further the condition so we can treat tricuspid disease seriously and appropriately. We also discussed the heterogeneity of tricuspid valve disease and the fact that we have to look very closely at the echocardiographic readings, etiology and severity of disease to put the indications for surgery into perspective.
Sarano教授:该专题的题目指的是,与二尖瓣或主动脉瓣疾病相比,三尖瓣疾病相对较少进行手术治疗。指南中有关三尖瓣疾病手术治疗的适应证也相对较少提到,其主要原因是,我们对三尖瓣疾病的了解真的还不像对二尖瓣或主动脉瓣疾病的了解那么多。在该专题讨论会上,我们就有关三尖瓣疾病结局的新数据进行了讨论,这将有助于我们对三尖瓣疾病进行进一步探索研究从而更认真、更妥善地治疗三尖瓣疾病。此外,我们还讨论了三尖瓣疾病的异质性,并就“从手术指征而言,我们需要密切关注三尖瓣疾病患者的超声心动图结果、病因及疾病严重程度”这一事实进行了探讨。
International Circulation: Can you explain the essential management of the valvular disease patient?
《国际循环》:能否请您解释一下瓣膜疾病患者的基本管理?
Dr Sarano: In the session today, we not only discussed the operative management, but also the newer management of aortic valve replacement which has been progressively increasing over the past ten years and the new devices we are going to be using. Valve disease has changed from a single valve replacement technique to a multitude of approaches and treatments with various devices, which are mostly experimental at the moment, but will be used more and more. That emphasizes the essential role of the accuracy of diagnosis because we are going to have so many ways of treating patients. The aim will be the treatment of an accurately diagnosed severe valve disease that will be defined mostly by Doppler echo but also other clinical and imaging techniques.
Sarano教授:在今天的会议上,我们不仅就手术管理作了讨论,还就主动脉瓣置换术这一过去十年间应用逐渐增多的新管理方法以及即将应用的新设备进行了探讨。瓣膜疾病的治疗已经从单一瓣膜置换术向多种方法及多种设备的综合治疗转变。当然,目前其中大多数新方法和新设备仍在试验阶段,但未来必将被越来越多地应用。鉴于我们即将有多种治疗方法,就瓣膜疾病患者的管理而言,准确诊断就发挥了关键作用。患者管理的目的便是对主要由多普勒超声心动图诊断但也需要其他临床及影像学技术辅助得以准确诊断的严重瓣膜疾病进行治疗。
International Circulation: You have pioneered many excellent studies involving Doppler echocardiography, valvular heart disease and left ventricular dysfunction. What exciting progresses in this field will we hear about in this meeting?
《国际循环》:您率先开展了多项有关多普勒超声心动图、瓣膜性心脏病及左心室功能不全的杰出研究。本届大会将传递该领域哪些令人兴奋的进展?
Dr Sarano: The new imaging techniques are giving us information we haven’t had previously, so we need to be reassessing ventricular and valvular function using these new methods to see what additional information we can gain. Global strain, for example. How does that help us in diagnosis? We are looking forward to this new information giving us new tools for use in clinical practice for the treatment of valvular heart disease.
Sarano教授:新的影像学技术将给我们提供很多过去无法获得的信息,因此我们需要采用这些新方法重新评估心室及瓣膜功能,看看我们能够获得怎样的额外信息。这将对我们诊断疾病有何帮助?我们期待着这种信息能给我们带来可在瓣膜性心脏病治疗临床实践中应用的新工具。