International Circulation: Our third question， what are the indications and results of functional ischemic mitral regurgitation repair or replace? How about the feasibility of the techniques?
《国际循环》：第三个问题是，功能性三尖瓣反流何时需要三尖瓣修补？如何修补？效果怎样？
Dr. Sarano: The treatment of functional mitral regurgitation is disputed. There are trials that have been done that have discordant results. At this time there is no clear advantage of doing a repair versus a replacement of the mitral valve so that the choice of using a valve replacement maintaining the cords of the mitral valve is something that is really possible to do at surgery. In general the indication that we have is that we prefer a repair when the valve is not too deformed by the left ventricular dysfunction and we prefer a valve replacement when there is too much valve tethering and tenting.
Sarano教授：功能性三尖瓣反流的治疗目前尚存争议，相关研究结果并不一致。目前与三尖瓣置换相比，瓣膜修补治疗尚无明确优势，因此在进行手术治疗时，我们仍然可以采用三尖瓣置换术来保持瓣膜的腱索。一般来说，在瓣膜未因左室功能不全发生严重变形时，我们可以优选瓣膜修补术，在瓣膜出现瓣环扩大及隆起时则优选三尖瓣置换术。
International Circulation: The last question is what about the latest update of percutaneous approaches to functional tricuspid regurgitation?
《国际循环》：最后一个问题是，经皮三尖瓣反流干预的最新进展如何？
Dr. Sarano: Tricuspid regurgitation is a very poorly known entity and its treatment is not well known. There are the surgical options -- valve replacement versus valve repair. We do valve replacement when the lesions are too severe such as too much tenting that predicts a recurrence after the repair but we prefer evidently when a simple repair can be done and in general we indicate surgery when there are not just severe tricuspid regurgitation but also symptom and signs of congestion. There are new options that are being developed for percutaneous treatment of tricuspid regurgitation， but no result is yet available so we will have to stay with the surgical treatment for now.
Sarano教授：人们对三尖瓣反流及其治疗的了解知之甚少。就手术治疗而言，有瓣膜置换术和瓣膜修补术两种选择。在瓣膜存在严重病变有很多隆起容易在修补术后出现复发时，我们可选择行瓣膜置换术。但是，在能够进行简单修补时我们显然还是更倾向于选择瓣膜修补术。一般来说，在患者不但存在重度三尖瓣反流，且伴有充血症状及体征时，我们会考虑手术治疗。目前还有经皮治疗三尖瓣反流的新方法正在研发过程中，但是目前尚无相关结果发布。因此，现在我们仍然只能选择手术治疗。
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