二尖瓣成形技术治疗儿童Barlow病的早期疗效

目的 总结二尖瓣成形技术治疗Barlow病合并二尖瓣中度以上反流患儿的临床疗效.方法 回顾性分析2014年1月至2019年8月阜外医院10例Barlow病合并二尖瓣中度以上反流≤ 18岁患儿的临床资料,其中男3例、女7例,平均年龄(8.7±7.9)岁.术前超声心动图和术中瓣膜分析均证实二尖瓣瓣叶冗长、甩动,瓣叶及对合缘...

Short-term outcomes of mitral valvuloplasty for Barlow disease in children

Objective To explore the clinical effect of mitral valvuloplasty on children with Barlow disease combined with moderate to severe or severe mitral regurgitation.Methods The clinical data of 10 patients with Barlow disease combined with moderate to severe or severe mitral regurgitation in Fuwai Hospital from January 2014 to August2019 were analyzed retrospectively,including 3 males and 7 females,with a mean age of 8.7±7.9 years.Echocardiography before and during the operation confirmed that the mitral valve leaflets were long and swinging,the valve leaflets and the opposite edge protruded into the left atrium and were higher than the level of the mitral valve rings,the mitral valve rings were dilated,the papillary muscles and tendons were long,and the pathological changes after the operation showed mucoid degenertion of the valve leaflets and tendons,and some fibrous foci hyperplasia.Mitral valve repair included implantation of artificial valve ring,implantation of artificial tendon,posterior leaflets sliding,partial resection of posterior leaflets(excluding sliding),valve leaflets folding,tendon folding,papillary muscle splitting and annular valve contraction(excluding artificial valve ring implantation).The technique of mitral valve repair,early clinical results and follow-up echocardiographic data were analyzed.Results All the patients successfully completed the mitral valve repair.The mean time of aortic occlusion was 73.2±17.4 min,and cardiopulmonary bypass time was 99.5±19.8 min.At the same time,4 patients received tricuspid valve repair and 1 funnel chest correction.There was no reoperation in perioperative period.The 1-year and 5-year survival rates were 100.0%and 100.0%,respectively.The incidence of below moderate mitral regurgitation was 90.0%at postoperative 1 year and 72.0%at postoperative 5 years.Conclusion For the young children who have Barlow disease and mitral regurgitation,considering the characteristics of heavy lesions,small operation space,and the need to meet the growth and development of valve,it is suggested to adopt the surgical techniques different from those of older children,such as valve ring retraction and tendon folding,if necessary,to adopt"edge to edge"suture,which can shorten aortic occlusion time and achieve good early effects,and its long-term effects still need further follow-up observation.Mitral valvuloplasty technique for Barlow disease similar to that of adults can be used in older children,including implantation of artificial valve ring and implantation of artificial tendon,etc.