改良二尖瓣成形术治疗小儿二尖瓣反流

Modified mitral valve annuloplasty for mitral valve regurgitation in children

目的总结改良二尖瓣成形术在小儿二尖瓣反流中的治疗经验。方法1999年3月至2009年12月共收治小二尖瓣中、重度反流行改良二尖瓣成形术患儿106例。全组男69例，女37例；年龄0．4～8．5岁，平均（3．7±1．8）岁；体重6．6～52．0kg，平均（10．0±3．5）kg。术前超声评估左心室功能。按年龄分为3组：〈6个月16例；6个月到2岁51例；2岁到8．5岁39例。另有7例合并二尖瓣狭窄，根据术前血流动力学、功能状况和解剖结构分别采用取不同的手术方法。结果死亡3例（2．8％），其中2例为术后二尖瓣反流加重严重影响心功能，1例为合并难以纠治的肺高压。其他患儿恢复良好。结论对于小儿二尖瓣反流行成形术可行，术后早期效果良好，瓣膜发育尚可，再手术率相对较低。对小儿二尖瓣反流早期干预可以减少瓣膜损害。

Objective To review and summarize the experiences of the modified mitral valve annuloplasty for mitral valve regurgitation （MR） in children. Methods One hundred and six patients with moderate to severe MR were retrospectively studied from March 1999 to December 2009. They aged from 0.4 to 8.5 years [ mean （ 3.7 ±1.8 ） years ] and weighted from 6.6 to 52.0 kg [mean（10.0 ±3.5）kg]. There were 69 males and 37 females. The heart function was evaluated by echocardiography. Patients were divided into three groups according to the age： group 1, 〈6 months , 16 cases; group 2, from 6 months to 2 years, 51 cases; and group 3, from 2 years to 8.5 years, 39 cases. Seven eases were MR combined with mitral valve stenosis. Different operations were performed according to preoperative homodynamic, heart function and anatomical structure. Results The operative mortality rate was 2.8%. In 3 died patients, 2 were due to MR and 1 due to severe pulmonary hypertension. 104 cases were recovered. All patients were followed up 3 months to 3 years. Conclusion Modified mitral valve reconstruction is necessary for children with moderate to severe MR. It should be the first choice for MR patients associated with other cardiac malfomation. This technique could prolong the time for mitral valve replacement when needed. Moreover, this technique not only reduces the valve injury but also decreases the reoperation rate.