先天性二尖瓣关闭不全的再次手术

Reoperation of congenital mitral regurgitation

目的:回顾性分析先天性二尖瓣关闭不全再次手术的问题。方法:自2002年至2009年间共438例先天性二尖瓣关闭不全(不包括完全性或部分性房室通道)患儿行二尖瓣成形手术,所有患儿中有15例(3.4%)行再次二尖瓣手术,其中再次行二尖瓣成形术12例(组1),二尖瓣置换术3例(组2)。再次手术的原因包括:严重溶血和残余或复发二尖瓣关闭不全。术中根据瓣膜病变情况选择合适的成形方法,包括二尖瓣瓣环环缩、腱索转移、双孔成形和瓣膜置换手术。对所有患者均行临床评估和超声心动图检查评估二尖瓣功能。结果:全组患儿无死亡病例,所有15例随访患儿亦无死亡。组2患儿年龄、体质量和心胸比均大于组1。组1患儿中术中见原缝线撕裂2例,瓣环扩大4例,瓣叶局部裂3例,组1患儿术后超声心动图见二尖瓣关闭不全较术前明显减轻(P<0.01)。组2中3例患儿均行二尖瓣双叶机械瓣置换。结论:二尖瓣成形术仍是先天性二尖瓣关闭不全再次手术的首选术式,对术前心功能差且瓣膜条件不理想的患儿行瓣膜置换手术是理智的选择。

Objective：To review the surgical results of congenital mitral regurgitation after reoperation.Methods：Of 438 consecutive patients with congenital mitral regurgitation（total and partial atrioventricular canal defect were not included） after surgical repair 15 patients（3.4%） were underwent reoperation from 2002 to 2009.Mitral valve reconstruction were performed in 12 cases（group 1） and the mitral valve were replaced with mechanical prosthetic valve in the other 3 patients（group 2）.The main causes of reoperation include：sever haemolysis and residual or recurrent mitral regurgitation.Ring annuloplasty,chordal transposition,double-orifice mitral valve shaping and mitral valve replacement were performed based on the pathological changes of the valve.The severity of the mitral regurgitation were evaluated with echocardiogram during and after the reoperation.Results：There were no early and later death during the follow-up.Tearing of suture line were found during the operation in 2 cases,ring dilation in 4 cases and valve leaflet cleavage in 3 cases.Mitral regurgitation was diminished significantly after reconstruction in group 1.Mechanical mitral valve replacement were performed in 3 patients.Conclusion：Reconstruction is still the first choice during the reoperation in congenital mitral regurgitation even in the presence of severe regurgitation.Valve replacement is a wise choice if the heart function is seriously compromised and the pathological changes of the valve is critically severe.