摘要
目的评估二尖瓣成形术治疗婴幼儿单纯二尖瓣关闭不全的中期临床疗效。方法回顾性分析2005年1月至2015年1月采用二尖瓣成形术治疗的婴幼儿单纯二尖瓣关闭不全40例的临床资料。其中，男9例，女31例；平均年龄（13±5）个月，一岁以内22例（55%）；平均体重（8.5±1.9）kg。二尖瓣大量反流27例，中大量反流10例，中量反流3例。术前平均左心室射血分数术为65.3%±10.1%，左心房直径为（28.0±8.2）mm，左心室直径为（37.9±7.5）mm。结果全组均成功在全身麻醉、低温体外循环下行二尖瓣成形术。术中平均体外循环时间为（78.2±34.3）min，主动脉阻断时间为（57.7±23.5）min，住院时间为（17.8±7.9）d。全组无术后早期死亡病例。术后一个月患儿平均左心房直径为（21.0±4.7）mm，左心室直径为（30.3±4.9）mm，与术前比较，差异均有统计学意义（P均〈0.05）。出院后有37例患儿完成中期随访，失访3例，随访率为92.5%，平均随诊时间（37±31）个月。中期随访时超声复查结果显示出现二尖瓣少量反流7例、少中量反流4例、中量反流3例、中大量反流1例，出现大量反流的1例于术后1年再次二尖瓣成形。中期随访时患儿平均左心房直径为（23.5±6.9）mm，左心室直径为（33.0±5.7）mm，与术前比较，差异均有统计学意义（P均〈0.05）。结论二尖瓣成形术治疗婴幼儿单纯二尖瓣关闭不全能获得良好术后及中期疗效。个体精确成形方法的组合应用能取得满意修复效果；二尖瓣瓣环扩大及前叶病变是术后二尖瓣反流再发及影响中期疗效的主要因素。
ObjectiveTo evaluated the midterm outcomes of mitral valvuloplasty in children.MethodsThe clinical data were retrospectively analyzed for 40 infants and young children of mitral insufficiency undergoing primary mitral valvuloplasty from January 2005 to January 2015.During this period, 40 children with moderate-severe mitral regurgitation （MR） aged （13±5） months and weighted （8.5±1.9） kilograms were operated.Twenty-two （55%） were aged under 12 months.MR was severe （n=27）, midterm-severe （n=10） and midterm （n=3）. The preoperative mean left ventricular ejection fraction was （65.3%±10.1%）, the mean preoperative left atrial diameter （28±8.2） mm and the mean left ventricle diameter （37.9±7.5） mm.ResultsAll of them underwent mitral valvuloplasty under general anesthesia and hypothermic cardiopulmonary bypass （CPB）. Mean CPB time was （78.2±34.3） min and mean aortic clump time （57.2±23.5） min.There was no in-hospital mortality.Mean length of stay was （17.8±7.9） days.The mean left atrial diameter was （21.0±4.7） mm and the left ventricular diameter （30.3±4.9） mm at 1 month postoperatively.And the difference was statistically significant as compared with that preoperatively （P〈0.05）. For 37 cases （92.5%）, the average follow-up period was （37±31） months.Echocardiography showed that MR was mild （n=7）, mild-moderate （n=4）, moderate （n=3） and severe （n=1）. One patient underwent re-do mitral valve repair.There was no late mortality.The follow-up results showed that mean left atrial diameter was （23.5±6.9） mm and left ventricular diameter （33.0±5.7） mm.Both were significantly different from those preoperatively （P〈0.05）. The difference was statistically significant before and after follow-ups （P〈0.01）.ConclusionsSurgical repair of congenital mitral valve may be successfully performed with low mortality, satisfactory valvular function at midterm follow-up and acceptable reoperative rate.Patients with modera
作者
史艺
亦桐
张雅娟
刘文超
王强
李守军
闫军
Shi Yi;Yi Tong;Zhang Yajuan;Liu Wenchao;Wang Qiang;Li Shoujun;Yah Jun(Department of Cardiac Surgery, Fuwai Hospital, Natiollal Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences＆ Peking Union Medical College, Beijing 100037, China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2018年第3期196-199,共4页
Chinese Journal of Pediatric Surgery
