摘要
目的 探讨儿童心脏瓣膜置换手术及治疗效果。方法 1990年 1月至 2 0 0 2年 12月 ,4 5例14岁以下儿童施行了心脏瓣膜置换手术。其中男 2 6例 ,女 19例。年龄 3～ 14岁 ,平均 10 8岁 ;≤ 10岁15例 ,10～ 14岁 30例。包括先天性心脏瓣膜病 32例 ,风湿性瓣膜病 6例 ,心内膜炎 3例 ,部分型房室管畸形修补术后二尖瓣关闭不全 3例 ,室间隔缺损修补术后主动脉关闭不全 1例。行二尖瓣置换 2 3例 ,其中 2例为矫正型大动脉转位行解剖位三尖瓣置换 ,主动脉瓣置换 9例 ;二尖瓣与主动脉瓣双瓣置换 4例 ;三尖瓣置换 9例。 5例使用生物瓣膜或同种主动脉瓣 ,余 4 0例均采用机械瓣膜 ,包括进口双叶瓣 34枚 ,进口单叶瓣 3枚 ,国产单叶瓣 7枚。结果 本组手术死亡 (术后 30d内 ) 2例 ,死亡率 4 4 % ,均死于手术当日 ,1例因顽固性心律失常 ,1例术后低心输出量综合征。生存者随访 8个月～ 12年 ,平均 4 9年。 4例晚期死亡 ,晚期死亡率 9 3%。置入机械瓣膜者均采用华法林抗凝治疗 ,未发生血栓栓塞及抗凝相关并发症 ,病儿术后心功能均I～II级。结论 儿童瓣膜病病人 ,大多数可以置入合适的成人型号人工瓣膜 ,保证其术后生长发育 ,减少二次手术。采用华法林进行抗凝治疗 ,经过平均 4 5年随访 ,无血栓栓塞或抗凝有关的出血?
Objective: To summarize the surgical results of valve replacement in children. Methods: From Jan.1990 to Dec.2002, 45 children ranging from 3 to 14 years (average 10.8 years) underwent cardiac valve replacement. There were 26 males and 19 females. 15 cases were younger than 10 years and 30 cases aged 10 to 14 years. Surgical indications for valve replacement included congenital valve disease (n=32), rheumatic heart disease (n=6), bacterial endocarditis (n=3), mitral insufficiency after atrioventricular canal defect repairing (n=3) and aortic insufficiency after VSD repairing (n=1). Mitral replacement was performed in 23 cases, aortic and tricuspid replacement in 9 cases, and combined mitral and aortic replacement in 4 cases. In forty cases, mechanical valves were used bioprosthetic valves or homograft valves in 5 cases. Results: Operation mortality was 4 4%(2/45 cases). The follow up periods were from 8 months to 12 years (average 4 9 years). Late mortality was 9 3% (4/45 cases). There was no anticoagulation related complications occurring. Conclusion: According to this study, valve replacement with warfarin anticoagulation in children was a safe and feasible technique. A suitable size prosthesis implantation could result in a healthy development.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2004年第3期136-138,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
