二尖瓣成形治疗小儿二尖瓣关闭不全

目的 总结小儿二尖瓣关闭不全外科矫治经验。方法 回顾近12年我院收治75例小儿二尖瓣关闭不全患，其中男31例，女44例，年龄1．5－12岁，平均7．1岁。单纯二尖瓣关闭不全8例，合并其它心血管畸形67例。二尖瓣关闭不全轻度7例，中度47例，重度21例。二尖瓣脱垂24例，瓣叶裂38例，瓣叶发育不良2例，单纯二尖瓣环扩大11例。手术在中低温体外循环心内直视下进行，行腱索缩短13例（含多根腱索缩短4例），乳头肌缩短1例，腱索移植3例，瓣叶修复41例，瓣环成形25例，二尖瓣置换2例。同时矫正合并心血管畸形。结果 全组无手术死亡。完全矫正二尖瓣关闭不全54例（71．2％），残留少量反流17例（23．3％），中度反流4例（5．5％）。术后随访1．5－13年（平均7．8年），1例术后4．5年因急性左心衰再次行人工瓣置换术，1例合并严重肺动脉高血压术后5年死于右心衰竭，1例人工瓣置换术后失访。其余患发育良好，心功能均恢复正常。结论 二尖瓣成形术治疗小儿二尖瓣关闭不全可取得良好的效果。

Mitral valve repair for mitral insufficiency in children

Objective Mitral insufficiency(MI) in children may be surgically repaired but sometimes it also presents a challenge to the cardiac surgeon. This paper is to summarize the experience in surgical repair of this anomaly. Patients and Methods Seventy-five patients underwent surgery for MI in our hospital from June 1987 to June 1999. Thirty-one patients were males and forty-four females. Their age ranged from 1.5 to 12 years (mean of 7.1 years). There were 8 patients with pure MI and 67 with coexisted other cardiac anomaly. In the total group, 7 patients had mild MI, 47 moderate MI and 21 severe MI.Etiologic factors were mitral valve prolapse in 24, mitral leaflet with cleft in 38, leaflet hypoplasia in 2, pure annular dilation in 11. The surgical procedures were chordae shortening in 13 (including multiple chordae shortening in 4), papillary muscle shortening in 1; chordae transplant in 3; leaflet repair in 41; annuloplasty in 25. Mitral valve replacement in 2. Results There was no operative mortality. MI was completely corrected in 52(71.2%), resedual slight MI is present in 17(23.3%), and moderate MI in 4 (5.5%). Follow-up duration ranged from 1.5 to 13 years (mean of 7.8 years). One patient required mitral valve replacement for acute left heart failure 4.5 years after initial repaired. One patient with severe pulmonary hypertension died 5 years after valve repair because of right heart failure. One patient with mitral valve replacement was lost to follow-up. In the others the development was normal and heart function was completely recovered. Conclusions Mitral valve reconstructional procedure for mitral insufficiency in children can achieve good long-term results.