Fan Ming,Mo Xuming,Chen Jun,et al.Clinical efficacy of mitral valve insufficiency reconstruction in children[J].Journal of Clinical Pediatric Surgery,2020,19(06):513-517.[doi:10.3969/j.issn.1671-6353.2020.06.010]
小儿二尖瓣关闭不全瓣膜成形术的临床疗效分析
- Title:
- Clinical efficacy of mitral valve insufficiency reconstruction in children
- Keywords:
- Mitral Valve Insufficiency; Valvuloplasty; Treatment Outcome; Child
- 分类号:
- R726.1;R725.4;R542.5+1
- 摘要:
- 目的 回顾性分析二尖瓣成形术在治疗小儿二尖瓣关闭不全中的临床疗效。方法 收集2012年1月至2019年1月南京医科大学附属儿童医院心胸外科202例采用二尖瓣成形术治疗的二尖瓣关闭不全（排除房室间隔缺损）患儿作为研究对象。采用超声心动图评价患儿手术前后左心室功能及二尖瓣反流程度的改善情况，分析随访结果。本组患儿中男童84例，女童118例，手术年龄为（21.2±33.3）个月，体质量为（9.92±6.75） kg。瓣叶活动正常型112例，瓣叶脱垂型54例，瓣叶活动异常型36例。所有患儿在中低温体外循环下行二尖瓣成形术（瓣叶修补、瓣环扩大、二尖瓣双孔成形等），体外循环时间（75.89±51.36） min，平均主动脉阻断时间为（45.65±17.89） min，合并其他心脏畸形者行同期矫治术。结果 所有患儿中，无术中死亡病例；术后早期死亡5例；术后晚期死亡3例；术后多次行二尖瓣成形术15例，其中死亡1例。平均随访时间（19.49±17.48个）月。所有患儿行超声心动图评估手术前后左心室以及二尖瓣功能，其中左心室舒张末期内径（left ventricular end diastolic dimension，LVDD）、左房内径（left atrial dimension，LAD）、主肺动脉内径（main pulmonary artery dimension，MPA）与术前相比改善明显（P<0.05）。术后1年心功能分级（New York Heart Association，NYHA）与术前相比亦有明显改善（P<0.05）。结论 二尖瓣成形术是一门综合技术，根据病情不同选择的不同方法可以很好纠正小儿二尖瓣关闭不全，临床疗效满意。
- Abstract:
- Objective To review the clinical efficacy of mitral valve reconstruction for mitral regurgitation in children.Methods From January 2012 to January 2019,clinical data were collected for 202 children with congenital mitral insufficiency undergoing mitral reconstruction.The improvements of left ventricular function and mitral regurgitation before and after surgery were evaluated by echocardiography and the follow-up outcomes were analyzed.There were 84 boys and 118 girls with an operative age of(21.2±33.3)(1-179)months and a body weight of(9.92±6.75)(3.2-49)kilogram.There were normal valve activity(n=112),valve prolapse(n=54)and abnormal valve activity(n=36).All children underwent mitral reconstructions(valve repairing,ring enlargement & double-hole plasty,etc.)during cardiopulmonary bypass (CPB) at low-moderate temperatures. The CPB time was (75.89±51.36) min and the mean aortic blocking time (45.65±17.89) min. Other concurrent cardiac malformations were corrected simultaneously. Results Without any intraoperative mortality,there were early(n=5)and late(n=3)postoperative death.Among 15 cases of multiple reconstruction,there was one case of death.The average follow-up period was(19.49±17.48)(1-68)months.All children underwent echocardiography for evaluating the differences in left ventricular and mitral valve function before and after surgery.The parameters of left ventricular end diastolic dimension(LVDD),left atrial dimension(LAD)and main pulmonary artery dimension(MPA)significantly improved as compared with those before surgery(P<0.05).And cardiac function classification of New York Heart Association(NYHA)significantly improved at 1 year after surgery as compared with that before surgery(P<0.05).The difference was statistically significant(P<0.05).Conclusion Mitral valve reconstruction improves mitral valve insufficiency in children and has a satisfactory clinical efficacy.
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备注/Memo
收稿日期:2019-10-03。
基金项目:十三五国家重点研发计划重大项目（编号：2016YFC1101000）；"先天性心脏病诊疗技术、疗效评价及康复的综合研究"项目子课题"改善法洛四联症远期预后综合研究及应用推广"课题（编号：81370279）
通讯作者:莫绪明,Email:mohsumingl5@sina.com