小儿合并中重度二尖瓣关闭不全的动脉导管未闭临床经验

目的:回顾性分析和总结动脉导管未闭(PDA)合并中重度二尖瓣关闭不全(MI)的治疗经验。方法:分析PDA合并中重度MI 59例患者的临床资料。年龄2个月~13岁,体质量4~32 kg,平均(9.1±4.8)kg。动脉导管未闭,主动脉端4.5~15 mm,平均(5.7±1.7)mm,肺动脉端3~14 mm,平均(9.1±2.5)mm。所有患者均合并中-重度MI,42例中度反流,17例重度反流。介入封堵27例;外科手术32例(3例因介入封堵失败转外科手术),外科手术患儿中有3例因合并有二尖瓣病理解剖病变经右侧开胸同期行PDA缝扎和二尖瓣成形术,其余29例经左胸后外侧行PDA缝扎术。结果:全组患者无死亡。出院超声心动图结果显示,PDA均无残余分流,二尖瓣反流较术前好转42(71.2%)例,明显改善至微少量反流有38(64.4%)例。出院后6个月复查49(83.1%)例二尖瓣反流较术前好转,43(72.9%)例明显好转至微-少量反流,3例行PDA缝扎+二尖瓣成形术的患者,二尖瓣由术前的重度反流变成微少量反流。56例单纯处理PDA患儿中,40(71.4%)例明显好转至微-少量反流。出院时较术前,LVEDD(36.4±8.0)vs.(43.2±8.2)mm,P<0.001],LVESD(23.5±5.1)vs.(26.2±6.0)mm,P<0.01],左心房内径(20.6±6.8)vs.(28.2±9.3)mm,P<0.001]均较术前显著缩小。结论:对于PDA合并中重度MI的患者,单纯介入封堵或者外科手术缝扎PDA可改善功能性MI的程度。合并有二尖瓣病理解剖病变的患儿开胸一期行PDA缝扎和二尖瓣成形术可以取得良好的效果。

Clinical experience sharing in treatment of patent ductus arteriosus with moderate to severe mitral insufficiency in children

Objective:Retrospective analysis and share the experience of the treatment of patent ductus arteriosus(PDA)with moderate to severe mitral insufficiency(MI).Methods:59 patients with PDA and moderate to severe MI were included in the study.The mean age was 1.6 years,ranging from 2 months to 13 years;and their mean weight was 9.1 kg,ranging from 4 to 32 kg.The mean size of aortic end of PDA is 4.5 mm,ranging from 4.5 to 15 mm and the pulmonary end is 9.1 mm,ranging from 3 to 14 mm.Among these 59 patients,42 patients had moderate regurgitation and 17 patients had severe regurgitation.Interventional occlusion of PDA was performed in 27 cases and surgical operation in 32 cases.Three patients with PDA underwent surgical treatment after failed transcatheter closure.Three patients underwent PDA suture and mitral valvuloplasty(MVP)in right thoracic posterior incision,and the others underwent PDA suture and ligation through left thoracic posterior incision.Results:There were no early and later death during the follow-up.The result of discharged echocardiography showed that there was no residual shunt in PDA.And mitral regurgitation(MR)improved in 42(71.2%)cases and significantly improved to micro to small regurgitation in 38 cases(64.4%).After 6 month of discharge,MR improved in 49(83.1%)cases and significantly improved to micro to small regurgitation in 43(72.9%)cases.In three patients who underwent PDA suture and MVP,MR improved from severe regurgitation to minimal to minor regurgitation.In 56 patients that underwent PDA treatment alone,MR improved from severe regurgitation to minimal to minor regurgitation in 40(71.4%)cases.Comparison of echocardiography at discharge and preoperation,LVEDD(36.4±8.0)vs.(43.2±8.2)mm,P<0.001],LVESD(23.5±5.1)vs.(26.2±6.0)mm,P<0.01]and left atrial diameter(LAD)(20.6±6.8)vs.(28.2±9.3)mm,P<0.001]were decreased significantly.Conclusions:For patients with PDA and moderate to severe MI,simple interventional occlusion or surgical suture of PDA can improve the level of MI.PDA suture and MVP can achieve good result in children with PDA and mitral valve pathological anatomic malformation.