先天性二尖瓣关闭不全患儿成形手术近中期结果分析

目的:总结先天性二尖瓣关闭不全患儿成形手术治疗的近中期结果。方法:选择自2016年1月至2018年1月因中重度二尖瓣关闭不全于我院行“三步法”二尖瓣成形术治疗的患儿70例。研究分析患者二尖瓣病变特征,术中操作要点,手术安全性和有效性,术后并发症及近中期随访结果。结果:70例患儿中男性31例,女性39例;年龄中位数23.83(四分位间距7.58,52.39)个月;身高85.50(67.75,105.25)cm;体重11.75(6.48,16.88)kg。手术均采用胸骨正中切口,均在全麻低温体外循环下进行。体外循环时间(102.10±40.65)min,主动脉阻断时间(67.76±32.97)min。术后住院15.50(11.75,25.75)天,术后早期死亡率为2.86%。术后二尖瓣中度以上关闭不全患者比例较术前显著降低(术前100%,术后7.14%;P<0.01)。术后随访20(17.45~26.30)个月。随访期间死亡率为1.5%,再次手术发生率为7.35%,二尖瓣中量以上反流发生率为14.71%。结论:“三步法”二尖瓣成形术是一种安全、有效的治疗方法,近中期结果良好,为二尖瓣关闭不全患儿提供了一种可靠的手术选择。

Short and Mid-term Outcome of Mitral Valvuloplasty for Pediatric Patients With Congenital Mitral Valve Regurgitation

Objectives:To summarize the short and mid-term outcome of surgical mitral valvuloplasty for pediatric patients with congenital mitral valve regurgitation.Methods:From January 2016 to January 2018,70 pediatric patients with moderate to severe mitral valve regurgitation underwent"three-steps"mitral valvuloplasty in Fuwai Hospital.The characteristics of mitral valve disease,key points of surgery,safety and effectiveness of operation,postoperative complications and short and mid-term follow-up results were analyzed.Results:There were 31 males and 39 females in this cohort,mean age was 23.83(7.58,52.39)months;height was 85.50(67.75,105.25)cm and body weight was 11.75(6.48,16.88)kg.All operations were performed through median sternotomy under general anesthesia and hypothermic cardiopulmonary bypass.The cardiopulmonary bypass time was(102.10±40.65)min and the aortic clamp time was(67.76±32.97)min.The hospital stay was 15.50(11.75,25.75)days after operation,and the early mortality rate was 2.86%.The ratio of patients with moderate or severe mitral regurgitation post operation was significantly lower than that before surgery(100%vs 7.14%,P<0.01).The average follow-up period was 20(17.45-26.30)months.During the follow-up period,the mortality rate was 1.5%,the rate of reoperation was 7.35%,and the rate of moderate and severe mitral regurgitation was 14.71%.Conclusions:The"three-steps"mitral valvuloplasty is a safe and effective treatment option with good results in the short and mid-term,which thus provides a good surgical option for pediatric patients with moderate to severe mitral valve regurgitation.