儿童瓣膜性心脏病的外科治疗

报道87例儿童瓣膜性心脏病患者的外科治疗。其中男58例，女29例，年龄4－14（平均10．2）岁，其中二尖瓣置换36例，主动脉瓣置换13例，二尖瓣和主动脉瓣双瓣置换6例，主动脉瓣成形13例，二尖瓣成形19例。所用心脏瓣膜均为机械瓣。同期处理三尖瓣关闭不全41例，室间隔缺损23例，房间隔缺损9例，佛氏窦瘤破裂8例，动脉导管未闭3例。术后早期并发症包括：低心排综合征7例，呼吸衰竭3例，心律失常5例。早期死亡4例，病死率4．60％。随访0．5－14．5（平均6．51）年，晚期死亡3例，病死率3．61％。儿童瓣膜性心脏病手术治疗时，首先应尽量选择瓣膜成形术；对人工心脏瓣膜替换术者，瓣膜尽量选用成人型号，术后常规行华法林抗凝治疗，并要重视对患儿术后风湿活动的治疗。

SURGICAL TREATMENT OF VALVULAR HEART DISEASE IN CHILDREN

The experiences of surgical treatment of valvular heart diseases in children were reported. Cardiac valve operations were performed in 87 children including 58 males and 29 females between the age of 4 to 14 years ( mean 10 2 years) . Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valves replacement, 6 mitral and aortic valves replacement, 13 aortic valvuloplasty, and 29 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Postoperative complications included low cardiac output syndromes in 7 patients, respiratory failure in 3, and arrhythmia in 5 patients. The operative mortality was 4 60% (4 patients). Follow up was 0 5 to 14 5 years (mean 6 51 years). Late mortality was 3 61% (3 patients). The valvuloplasty operations were first choice for cardiac valve operations in children. It was advisable to use cardiac valve prosthesis of larger size(adult) for valve replacement in children.Anticoagulation with Warfarin was routinely used and the treatment of rheumatic fever should be emphasized postoperatively.