儿童主动脉瓣病变的外科治疗策略

目的 探讨儿童主动脉瓣病变的外科治疗策略.方法 回顾性分析2010年1月至2016年1月间收治的13例主动脉瓣病变患儿的临床资料.其中,男9例,女4例;年龄1～12岁,年龄分布1～3岁6例,3～6岁3例,6～12岁4例;体重12～36 kg,平均24 kg.术前经心脏超声及心脏CT明确诊断,先天性主动脉瓣病变8例,后天获得性主动脉瓣病变5例.手术在全身麻醉、低温、体外循环下进行,结合超声、CT及术中情况决定手术方式.结果 全组13例中,行改良Ross手术4例,主动脉瓣成形术3例,主动脉瓣机械瓣置换手术3例,Bentall术1例,Ross手术2例.全组无手术死亡,术中采用冷血停跳液或冷晶体停跳液灌注,合并主动脉关闭不全时,切开直接灌注,术中均应用超滤.术后有效随访患儿11例,2例患儿未规律随访,随访时间6个月～5年,全部存活,正常生活不受影响.机械瓣置换的长期使用华法林抗凝,目前无并发症出现.2例随诊过程中发现瓣膜压差大于40 mmHg,一般状况可,随访中未发现明显瓣膜严重反流.结论 儿童主动脉瓣病变的外科治疗方法有多样性的特点,本文旨在为心外科医师在儿童主动脉瓣病变的治疗策略方面提供更多的临床经验,儿童主动脉瓣疾病治疗的临床效果还有待进一步探讨.

Surgical strategy of aortic valve disease in children

Objective To explore the strategies of surgical strategy of aortic valve lesions in children.Methods Between January 2010 and January 2016,a total of 13 children underwent surgery for aortic valve lesions in children.There were 9 boys and 4 girls with an age range of 1-12 years and an average weight of 24(12-36) kg.Age distribution:1-3 years (n =6),3-6 years (n =3) and 6-12 years (n =4).Preoperative findings of cardiac ultrasound and computed tomography (CT) revealed congenital aortic valve lesions (n =8),and acquired aortic lesions (n =5).Surgery was performed under general anesthesia,low temperature and extracorporeal circulation.Ultrasound,CT and intraoperative findings helped make a clinical decision.Results There were improved Ross procedure (n =4),arginine vasopressin (AVP) (n =3),aortic valve & mechanical valve replacement (AVR) (n =3),Bentall surgery (n =1) and Ross surgery (n =2).There was no instance of operative mortality.Effective postoperative follow-ups of 6 months to 5 years were conducted for 11 cases while 2 cases had no regular follow-ups.All survived complication-free with mechanical valve replacement of long-term use of warfarin anticoagulation.Two follow-up cases survived with a valve differential pressure of ＞ 40 mmHg.Conclusions Surgical treatment of aortic valve lesions has the characteristic of diversity in children.