少儿心脏瓣膜畸形的瓣膜置换术

目的 分析与评价少儿先天性心脏瓣膜畸形机械瓣膜置换的适应证、瓣膜选择、抗凝及疗效。方法 2000.3～2001.12,9例先天性心脏瓣膜畸形的少儿施行机械瓣膜置换术。年龄9～17岁,平均11.4岁。房室管畸形3例,二尖瓣中—重度返流3例,主动脉瓣中—重度返流2例,三尖瓣下移畸形1例。6例二尖瓣置换,2例主动脉瓣置换,1例三尖瓣置换。置入瓣膜内径:二尖瓣23～25mm,平均24mm;主动脉瓣21mm;三尖瓣33mm。结果 无手术死亡。9例随访2～20月,平均13月,无死亡及与瓣膜相关的并发症。抗凝过度胃出血1例。结论 少儿心脏瓣膜畸形机械瓣膜置换早中期效果满意。置入双叶机械瓣膜的内径,二尖瓣>23mm,主动脉瓣>21mm,三尖瓣>29mm可保证长期血流动力学的需要而无需再换瓣。少儿机械瓣置换术后仍需抗凝。

Mechanical Prosthesis Replacement in Congenital Heart Valve Anomalies in Juveniles

Objective Mechanical valves are the prostheses of choice in valve replacement in congenital heart valve anomalies. The study is aimed to analyze and evaluate the efficacy of mechanical prosthesis replacement in congenital heart valve anomalies in juveniles. Methods Between March 2000 to December 2001 ,9 patients ,with the mean age of 11.4 years ( range 9- 17 years) underwent mechanical prosthesis replacement at our institution. Of these patients, 6 had mitral valve replacement ( MVR) ,2 aortic valve replacement ( AYR) and 1tricuspid valve replacement ( TVR ). The mean size of the implanted prostheses was 24 mm (range; 23- 25mm) for MVR,21mm for AVR, and 33mm for TVR. Of these patients,3 was atrioventricular canal defect,3 were median lo severity mitral regurgitation ,2 median to severie aortic regurgitation and 1 Ebstein's anomaly. Results There was no early mortality. Nine patients were followed (or 2- 20months ( mean 13 months). There was no late death nor complications of mechanical prosthesis replacement. Gastric hemorrhagic events occured in one patient due to overanticoagulation. Conclusion Mechanical heart valve replacement in juveniles with congenital heart valve anomalies can be performed with early and late satisfactory results. Mechanical valves >23mm in diameter implanted in the mitral position, >21mm in the aortic orifice, and >29mm in the tricuspid position can offer excellent long - lasting hemodynamic performance. In our experience , anticoagulation is necessary in children undergoing mechanical valve implantation.