Liang Runzhang,Naijimuding Abudurexiti,Ling Jing,et al.Mid-term outcomes of mechanical pulmonary valve replacement in children with congenital heart malformations[J].Journal of Clinical Pediatric Surgery,,():830-834.[doi:10.3760/cma.j.cn101785-202505048-005]
Mid-term outcomes of mechanical pulmonary valve replacement in children with congenital heart malformations
- Keywords:
- Pulmonary Valve; Heart Diseases; Ventricular Dysfunction; Right; Anesthesia; Cardiac Procedures; Child
- Abstract:
- Objective To evaluate the mid-term outcomes of mechanical pulmonary valve replacement (PVR) in children with congenital heart malformations. Methods From January 2007 to January 2024, 19 children undergoing mechanical PVR were recruited.This cohort comprised of 10 boys and 9 girls with a mean age of (19.4±12.9) year, a median height of 158.5 cm (IQR: 117.5, 163.8) and a mean body weight of (40.8±20.4) kg.Comprehensive clinical perioperative evaluations were conducted. Results All of them successfully underwent mechanical PVR with a mean operative duration of (381.3±110.7) min, a mean cardiopulmonary bypass time of (208.4±83.18) min and a mean aortic cross-clamp time of (127.5±59.93) min.Postoperative outcomes demonstrated a median mechanical ventilation duration of 27.0 hour (IQR: 14.3-123.5), mean ICU stay of (6.0±4.71) day and median hospitalization stay of 11.5 day (IQR: 8.0-24.0).Preoperative assessments demonstrated: left atrial superoinferior diameter (35.4±10.1) mm; right atrial superoinferior diameter 47.0 mm (IQR: 38.0-47.8); right ventricular outflow tract (RVOT) anteroposterior diameter 25.5 mm (IQR: 19.8-26.0); pulmonary valve transvalvular gradient (59.3±32.6) mmHg; tricuspid regurgitant area index (4.2±3.1) cm2/m2; pulmonary regurgitant area index 5.5 cm2/m2 (IQR: 2.4-6.6); QRS duration (135.4±40.6) ms.Postoperative evaluations indicated: left atrial superoinferior dimension (34.1±5.6) mm; right atrial superoinferior dimension 47.0 mm (IQR: 36.3-49.8); RVOT anteroposterior dimension 26.0 mm (IQR: 20.3-29.5); pulmonary valve transvalvular gradient (16.6±5.3) mmHg; tricuspid regurgitant area index (2.2±2.7) cm2/m2; pulmonary regurgitant area index 2.1 cm2/m2 (IQR: 1.4-2.4); QRS duration (138.9±33.7) ms.Compared to preoperative levels, postoperative follow-up echocardiography revealed that pulmonary valve transvalvular gradient (P=0.02), tricuspid regurgitant area index (P=0.03) and pulmonary regurgitant area index (P=0.008) all significantly declined.During a median follow-up period of 40.0 (9.0-97.5) month, one child died from heart failure during hospitalization.The remainders survived without no onset of moderate or severe pulmonary valve regurgitation. Conclusions The mid-term outcomes of mechanical pulmonary valve replacement in children are excellent.However, vigorous anticoagulation managements are required for lowering the occurrence of complications.
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Memo
收稿日期:2025-5-29。
基金项目:易方达先心病医学人才培养教育基金(2023QT0009); 广州市科技计划(2023B03J1255)
通讯作者:温树生, Email: wenshusheng@gdph.org.cn