49例儿童心脏瓣膜替换术的经验

目的：报告儿童心脏瓣膜替换术的经验。方法：４９例儿童心脏瓣膜替换者，男３４例，女１５例，年龄５～１４（平均１１６）岁。其中行二尖瓣替换术３２例、主动脉瓣替换术１０例、二尖瓣加主动脉瓣双瓣替换术５例、三尖瓣替换术２例，所用心脏瓣膜均为机械瓣。同期处理合并的心脏病变。结果：术后早期并发症包括：低心输出量综合征５例，呼吸衰竭２例，心律失常２例。其中早期死亡３例，死亡率６１２％。随访０５～１３（平均５４７）年，晚期死亡３例（６５２％）。结论：儿童心脏瓣膜替换时，人工心脏瓣膜尽量选用成人型号，术后常规行华法林抗凝，并要重视对风湿性心脏病瓣膜替换患儿风湿活动的治疗

Experiences of Cardiac Valve Replacement in 49 Children

Objective:This paper reports the experience of cardiac valve replacement in children. Methods:Cardiac valve replacement with mechanical valve were performed in 49 children who were 34 male and 15 female between age of 5 to 14 years(mean 11 6 years).Of the 49 patients,32 underwent mitral valve replacement,10 aortic valve replacement,5 mitral and aortic valve replacement,2 tricuspid valve replacement.Associated cardiac lesions were simultaneously managed. Result:Postoperative complications included low cardiac output syndromes in 5 patients,respiratory failure in 2 and arrhythmia in 2 patients.The operative mortality was 6 12%(3 patients).Follow up was 0 5 to 13 years(mean 5.47 years).Late mortality was 6.52%(3 patients). Conclusion:The larger size(for adult)of cardiac valve prosthesis was chosen for valve replacement in children.The anticoagulation with Warfarin was routinely used and the treatment of rheumatic fever should be emphasized postoperatively.