儿童先天性二尖瓣疾病的外科治疗及中期随访研究

目的探讨儿童先天性二尖瓣疾病外科手术的疗效及中期随访结果分析。方法回顾分析2009年1月至2017年12月在复旦大学附属儿科医院心血管中心接受二尖瓣成形术的患儿92例。其中,二尖瓣狭窄患儿26例(二尖瓣狭窄组),二尖瓣关闭不全患儿66例(二尖瓣关闭不全组);男44例,女48例;手术年龄为(42.55±40.57)个月,范围为1个月至14岁,22.8%(21/92)患儿的年龄<1岁。结果4.3%(4/92)的患儿于手术早期死亡,3.3%(3/92)的患儿在随访期间死亡,总病死率为7.6%。术后所有患儿的心功能分级改善明显,Ⅲ级3例,余均在Ⅱ级及以上,随访时间为(42.72±29.66)个月,随访时间范围为3~104个月。随访期间11例患儿共接受了17次再手术,所有患儿的再手术率为12.0%(11/92)。二尖瓣狭窄组与二尖瓣关闭不全组在生存率及免除再手术率的Log Rank分析中,差异无统计学意义。所有患儿中<1岁的患儿较>1岁的患儿具有更高的病死率(P=0.045)及再手术率(P=0.039),差异均具有统计学意义。结论二尖瓣成形手术对于治疗先天性二尖瓣疾病的效果显著。但婴幼儿,特别是年龄<1岁的患儿,先天性二尖瓣疾病的修补手术仍面临着巨大挑战。虽然部分患儿需多次手术,瓣膜成形术仍是再手术时首要考虑的手术方式。

Surgical approaches and mid-term outcomes of congenital mitral valve diseases in children

Objective To review the surgical approaches and mid-term outcomes of congenital mitral valve diseases in children.Methods From January 2009 to December 2017,retrospective review was performed for 92 children undergoing mitral valvuloplasty for mitral stenosis(n=26)and mitral regurgitation(n=66).There were 44 boys and 48 girls with an average operative age of(42.55±40.57)(1-168)months.And 21/92(22.8%)were aged under 1 year.Results Four cases(4.3%)died within an early stage of operation and 3 cases(3.3%)passed away during follow-ups.The total mortality rate was 7.6%.The grade of cardiac function improved significantly in all the children after surgery,including 3 patients with gradeⅢ,and the rest were gradeⅡor above.During a follow-up period of(42.72±29.66)(3-104)months,11 children(12.0%)underwent 17 reoperations.Log Rank analysis revealed that no significant inter-group difference existed in death or reoperation.Children aged under 1 year had higher mortality and rate of reoperation than those aged over 1 year(P=0.045 and P=0.039).Conclusions Mitral valvuloplasty is efficacious for congenital mitral valve diseases.However,repairing mitral valves remains a challenge in infants,especially those aged under 1 year.Although some children require multiple reoperations,valvuloplasty is still the most important method of reoperation.