婴幼儿二尖瓣关闭不全的成形术

总结１９９０年４月至１９９５年１２月收治婴幼儿二尖瓣关闭不全（ＭＩ）成形术的临床经验。本组７１例中男３５例、女３６例，年龄５个月～３岁、平均２．１岁，体重６～１４ｋｇ、平均１０．２ｋｇ，４１例（５７．８％）＜１０ｋｇ。重度二尖瓣关闭不全１６例，中度４４例，轻度１１例。主要病种包括：单纯ＭＩ３例，ＭＩ＋室间隔缺损和（或）动脉导管未闭３５例，ＭＩ＋房间隔缺损或单心房２２例（Ｉ孔型１６例，Ｉ孔型６例；单心房４例），ＭＩ＋Ｉ孔房间隔缺损和室间隔缺损１１例。手术根据二尖瓣的病理采用瓣交界缝缩、瓣环环缩、修补前瓣叶裂、腱索短缩及转移和后瓣叶成形及共同房室瓣修补等方法修复二尖瓣。同期矫治其它心内畸形。结果术后早期死亡４例（术后感染和低心排综合征各２例），死亡率５．６％。６７例出院病儿中４２例（６２．７％）随诊２个月～５年，平均１．１年。轻度二尖瓣关闭不全５例，中度４例，无重度者；心脏明显缩小。作者认为婴幼儿二尖瓣关闭不全可采用瓣膜成形术治疗，并能取得良好的术后早期和晚期结果。

Repair Surgery of Mitral Valve Incompetence in 42 Infants and Children Under 3 Years of Age

Objective:This article is to review the expericnce of surgical repair of congenital mitral valve incompetence in infants and young children.Method:Forty two infants and children between the age of 10 months and 3 years (mean 2.1 years) and weighing 6.5 kg to 14 kg (mean 10.9 kg) underwent mitral repair under CPB through April 1990 to December 1994.Congenital mitral incompetence was present as an isolated anomaly in 4 cases and coexising with VSD in 19,ASD in 18(primum in 13 cases and secundum in 4),tricuspid valve incompetence in 8,PDA in 4,aortic valve incompetence in 2 and single ventricle in 2.The mitral incompetence was graded as severe in 11 cases,moderate in 27 and slight in 4.Mitral annuloplasty performed in 17 cases,repair of the cleft of the mitral leaflet in 19,chordal shortening in 6,chordal substitution in 6 and reconstruction of the posterior leaflet in 2.The modified annuloplasty allows natural growth of the annulus.The associated cardiac anomalies were totally corrected.There were two early deaths (mortality of 4.8%),one due to heart failure and the other due to severe intracardiac infection.Follow up of 23 patients out of 40 fsurvivors for 2 months to 4 years (average 1.6 years)found no late death.Conclusion:Mitral valve surgical repair in infants and children under 3 years of age can be done with good results.