肺动脉高压患者三尖瓣反流的矫正。

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-08 DOI:10.1016/j.jaccas.2025.105323

Antonio Orlando MD , Andrea Vergara MD , Robert Naeije MD, PhD , Michele D'Alto MD, PhD

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引用次数: 0

摘要

背景：肺动脉高压是矫正三尖瓣反流的禁忌症。病例总结：一名75岁的意大利女性，既往有右心衰发作，被诊断为世界卫生组织（WHO）功能性IV级肺动脉高压（PAH）并发三尖瓣强流反流。在使用利尿剂、马西坦和他达拉非治疗6个月后，患者的肺血管阻力（PVR）从5.4个Wood单位降至3个Wood单位，改善至WHO功能III级。随后，她接受了经导管瓣膜修复。一年后，她进入了WHO功能I级，PVR为2.2 Wood units。讨论：PAH患者右心衰伴PVR中度升高可能由严重的三尖瓣不全引起。在优化的医学治疗下，狭窄瓣修复可能会成功。关键信息：PAH患者严重的三尖瓣反流可能是右心衰的主要原因，在最佳药物治疗下可经导管修复。

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Correction of Tricuspid Regurgitation in Pulmonary Arterial Hypertension

Background

Pulmonary hypertension is a contraindication to correction of tricuspid regurgitation.

Case Summary

A 75-year-old Italian woman with previous episodes of right heart failure was diagnosed with World Health Organization (WHO) functional class IV pulmonary arterial hypertension (PAH) complicated by torrential tricuspid regurgitation. After 6 months of treatment with diuretic agents, macitentan, and tadalafil, she improved to WHO functional class III, with a pulmonary vascular resistance (PVR) decreasing from 5.4 to 3 Wood units. She then underwent transcatheter valve repair. One year later, she was in WHO functional class I with a PVR of 2.2 Wood units.

Discussion

Right heart failure with a moderate increase in PVR in PAH may be caused by severe tricuspid insufficiency. Transtricuspid valve repair under optimized medical treatment may then be successful.

Take-Home Message

Severe tricuspid regurgitation in PAH may be the dominant cause of right heart failure and is amenable to transcatheter repair under optimal medical therapy.

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