12岁以下儿童心脏瓣膜置换术的临床特点及中远期随访

Heart Valve Replacement in Children under 12 Year-Old and the Mid-Long Term Follow-Up

目的总结12岁以下儿童心脏瓣膜替换术的临床特点及中、远期随访结果 ,初步探讨手术适应证及需要注意的问题。方法本院1999年8月-2009年8月对12岁以下的15例心脏瓣膜病患儿行瓣膜替换术。男9例,女6例;年龄5～12岁,平均8.7岁。手术均在中度低温(24～28℃)体外循环下进行,其中二尖瓣替换12例,主动脉瓣替换2例,三尖瓣替换1例,均采用机械瓣膜。同期合并手术,三尖瓣成型4例,VSD修补2例,主动脉窦瘤破裂修补1例。结果全组无手术死亡病例。术后出现并发症4例(26.7%),其中恶性室性心律失常2例,呼吸衰竭、急性肾衰竭各1例,均经治疗后痊愈。随访7～120个月,平均81个月。随访期死亡3例(20%)。机械瓣功能障碍再手术1例,机械瓣功能障碍观察中1例。余10例瓣膜功能良好,NYHA心功能Ⅰ、Ⅱ级。结论对12岁以下儿童行瓣膜置换术,近期疗效尚可,但术后并发症及中、远病死率较高,应慎重把握手术适应证。

Objective To summarize the clinical characteristics and mid - long term efficacy of heart valve replacement in children who under 12 year-old. Methods From Aug. 1999 to Aug. 2009,15 children, aged 5 to 12 year -old, underwent heart valve replacement in Anzhen Hopital AfiSliated to Capital Medical University. There were 9 male and 6 female with mean age of （ 8.7 ± 2.6） years old. All operations were practiced with cardiopulmonary bypass with mid - low temperature （24 - 28 ℃ ）, including 12 cases with mitral valve replacement, 2 cases with aortic valve replacement and 1 with case tricuspid valve replacement. The mechanical artificial valve was chosen to replace the sick valve. There were 3 cases with additional tricuspid valve plasty,2 cases with additional ventrical septum rupture repair and 1 case with additional sinus valsalvae aneurism rupture repair. Results No patient died. Four cases had complications （26.7%）, including malignant ven- trieular arrhythmia（2 cases） ,respiratory failure（ 1 case） and acute renal failure（ 1 case）. All of the 4 children were cured. Time of 7 - 120 months[ average time of （81 _± 12） months] follow - up was made for the 15 children. There were 3 children（20% ） died during the follow - up period and 2 cases got mechanical valve malfunction,one of which received redo -heart valve replacement. The other 10 children were in good condition with New York Heart Association （NYHA） classification I , lI. Conclusions The short - term efficacy of heart valve replacement in children under 12 year- old is optimistic but the postoperative complication and mid -long term mortality are high,thus the rational cases with caution should be selected.