瓣膜成形术在婴幼儿二尖瓣关闭不全中的应用

Application of valvuloplasty in mitral valve insufficiency in infants and small children

目的总结瓣膜成形术在婴幼儿二尖瓣关闭不全(mitral regurgitation,MR)中的应用经验,为临床治疗提供依据.方法回顾性分析2015年1月至2017年12月在西部战区总医院心外科行二尖瓣成形术的3岁以内患儿.常规在全身麻醉下进行体外循环心脏手术,结合Carpentier分型选择合适的成形方法.患儿出院前均复查心脏彩超.术后对患儿进行随访,记录二尖瓣反流情况.结果共纳入69例患儿,其中男30例,女39例;年龄(19.3±11.6)个月;体质量(9.6±2.1)kg.CarpentierⅠ型32例、Ⅱ型30例、Ⅲ型7例.29例患儿为单纯MR,40例合并其他心脏畸形.3例在术中再次转机行二尖瓣成形(4.3%),1例在术后第7天死亡.出院前复查心脏彩超,无反流21例、轻度反流35例、中度反流12例,1例术后仍存在重度反流,在术后第10天进行二次手术.对65例患儿进行随访,随访时间1个月~3年[(15.9±10.9)个月],随访期间无死亡、无再次手术,4例患儿出现二尖瓣反流加重.结论二尖瓣成形术是治疗婴幼儿MR的一项安全有效的外科手段,选择合适的个体化成形方法是手术成功的关键,同时要充分考虑二尖瓣的生长发育潜能,避免限制发育.

Objective To explore the efficacy of valvuloplasty on mitral valve regurgitation(MR)in infants and small children,in order to provide evidence for clinical treatment.Methods Retrospective analysis was conducted in patients aged less than 3 years old who have undergone mitral repair surgeries at Department of Cardiovascular Surgery,General Hospital of Western Theater Command from January 2015 to December 2017.Cardiopulmonary bypass(CPB)surgery was performed under general anesthesia.The corresponding repair operations were selected for various MR types.All the children were examined by cardiac ultrasound before discharge.Patients were followed up after surgery and mitral regurgitation was recorded.Results A total of 69 patients were enrolled,including 30 boys and 39 girls,with an average age of(19.3±11.6)months and an average weight of(9.6±2.1)kg.There were 32 cases of Carpentier typeⅠ,30 cases of typeⅡand 7 cases of typeⅢ.Twenty-nine patients were diagnosed as simple MR,while the other 40 patients were combined with other cardiac malformations.One patient died at postoperative day 7.One patient still had severe MR after surgery,and then second operation was performed on the 10th day after first surgery.Sixty-five patients were followed up from 1 month to 3 years[(15.9±10.9)months].During the follow-up period,no patient died or had reoperation.Aggravated MR was observed in 4 patients.Conclusions Mitral valvuloplasty is a safe and effective surgical method for treating infants and younger children with MR.The key to the success of surgery is to choose the appropriate individualized repair operation.At the same time,the growth potential of mitral valve should be fully considered to avoid restrained development.