瓣环扩大在儿童主动脉瓣膜置换术中的应用

Patch enlargement of aortic annulus in children undergoing aortic valve replacement

目的总结6例儿童主动脉瓣膜置换术中主动脉瓣环扩大的经验,探讨儿童主动脉瓣置换时主动脉瓣环细小的外科处理方法。方法主动脉瓣膜置换术中进行瓣环扩大术6例,年龄7～14岁,平均(11.2±3.3)岁;体重20～41.5kg,平均(29.5±8.6)kg,体表面积0.8～1.35 m^2,平均(1.08±0.23)m^2。术前测定主动脉瓣环直径13.5～18.7 mm,平均(15.9±2.6)mm。术中主动脉瓣环扩大2例采用Manouguian法,4例采用Konno法。经瓣环扩大后,主动脉瓣环植入了平均直径(19.2±1.3)mm (17～21 mm)的机械瓣膜。其他心脏畸形也在术中予以矫治。结果无住院死亡。随访时间3～89个月,无晚期死亡,无再次手术。NYHA心功能分级均为Ⅰ级。复查超声心动图2例存在跨瓣压差,分别为25 mmHg和40 mmHg。结论儿童主动脉瓣膜置换术中,采用主动脉瓣环扩大术,特别是Konno法,可有效扩大狭窄的主动脉瓣环,植入较大的人工瓣膜,提高手术的成功率,改善远期疗效。

Objective To review our experience with the patch enlargement of aortic annulus in 6 children undergoing aortic valve replacement with mechanical valves. Methods Since 1998,6 children with small aortic annuli underwent valve replacement either isolated or combined with other procedures in this institute. Children＇s age ranged from 7 to 14 years,mean 11.2 ± 3. 3 years. The body weights ranged from 20 to 41.5 kg,mean 29. 5 ± 8.6 kg. The body surface area ranged from 0. 8 to 1.35 m^2 , mean 1.08 ± 0. 23 m^2. Manouguian method was used in 2 children,and Konno procedure used in 4 children. The aortic annulus before enlargement ranged in diameter from 13. 5 to 18. 7 mm with an average of 15.9 ram. After enlargement,the diameter of the annulus was 19. 2 mm on average. The aortic mechanical valve was secured to the newly reconstructed aortic annulus. Results There was no early death or late death. The follow-up ranged from 3 to 89 months （mean,30 months）. There was no reoperation. All 6 children were in NYHA class I. Recent echocardiography Doppler documented a transprosthetic gradient across the aortic valve of 25 mmHg and 40 mmHg in 2 children. Conclusions Patch enlargement of the small aortic annulus in children, especially the Konno procedure, is a safe and effective treatment permitting the insertion of a valve larger than that which could be accommodated by the native annulus. It may favorably affect the clinical outcome and late survival.