儿童替换猪生物瓣膜15例疗效观察

Follow-up study of porcine bioprosthetic valve replacement in 15 children

作者自１９７８年７月至１９８２年１１月用ＧＤ－Ｉ型猪生物瓣膜为１５例８～１４岁儿童进行瓣膜替换术，其中二尖瓣替换１３例，主动脉瓣替换１例，三尖瓣替换１例。手术死亡率为６．７％。随访３～１０年，近期疗效满意，远期疗效较差。主要原因是生物瓣膜失功能，其生物瓣膜衰坏率达１９．３７％病人年，远较成年人替换猪生物瓣膜的衰坏率３．６９％病人年为高。本文对儿童替换猪生物瓣膜较早出现失功能的原因进行了探讨。

AbstractGD-I porcine bioprosthetic valve replacement wereperformed in 15 cases from Jul. 1978 to Nov. 1982.Pathology:RHD 11,CHD 4,13 withMVR,1 AVR,1 TVR. One patient died during operation(operativemortality 6.7%).13 cases were followed up for 3～10years: in the early years the symptoms and cardiacfunction were greatly improved and the size reduced.However dysfunction of bioprosthetic valve was detected 2～8 years after operation in 12 patients(19. 37%/patient year).The main cause of damage and dysfunction of porcine valve is calcification of the leaflet.Ascompared with the adult group(dysfuction rate 3.6%/patient year) in this institute,more calcification of thepocine valve in children is considered because of :(1)stronger metabolism of calcium in children,(2)lessmobility of the leaflet due to lower cardiac output inchildren,and(3 )stronger immunoreaction to porcinevalve in children.