学龄前儿童瓣膜成形术

Operative valvuloplasty in 283 children under the age of 6

目的 探讨学龄前儿童瓣膜疾患行瓣膜成形术的疗效。方法 总结 1990年 1月～1998年 4月收治的学龄前儿童瓣膜疾患 2 83例 ,男 130例 ,女 15 3例。年龄 2个月～ 6岁 ,平均 3.0 5岁 ,其中≤ 1岁 2 2例 (7.77% ) ,≤ 3岁 170例 (6 0 .0 7% )。体重 3.1～ 2 1.0kg ,平均11.84kg ,,≤ 10kg10 6例 (37.46 % )。主要瓣膜疾患包括 :单纯瓣膜疾病 9例 (3.18% ) ,其中二尖瓣关闭不全 (MI) 7例 ,主动脉瓣关闭不全 (AI)和三尖瓣关闭不全 (TI)各 1例 ;合并其他心内畸形或多瓣膜病变 2 74例(96 .81% ) ,其中MI 15 8例 (5 5 .83% ) ,TI 2 6例 (9.18% ) ,AI 11例 (3.88% ) ,MI +TI 12例(4.2 4% ) ,共同房室瓣 44例 (15 .18% ) ,肺动脉瓣狭窄 (PS)和 /或TI与MI12例 (4.2 4% ) ,二尖瓣狭窄 (MS)、三尖瓣狭窄 (TS)、主动脉瓣狭窄 (AS)等共 11例 (3.88% )。根据不同瓣膜的具体病理改变 ,对 2 83例患儿 36 9个瓣膜采取相应的瓣膜成形术 :瓣叶修补、瓣交界环缩、DeVega环缩、腱索转移、瓣叶成形、瓣交界切开等。同期矫治心内其他畸形。结果 术后早期死亡 8例 ,占 2 .82 % ,死亡原因低心排综合症 3例 ,感染及肺动脉高压危象各 2例 ,脑昏迷 1例。随访 2 5 6例 ,随访率 90 .45 % ,时间 2～ 90个月 ,平均 38.6个月 ,无远期死亡 ,

Objective To review the results of operative valvuloplasty in preschool children.Methods Two hundred and eighty three preschool children between the age of 2 months and 6 years (mean = 3.05 years) with weight between 3.1 kg to 21 kg (mean=11.8 kg) underwent valvuloplasty under cardiopulmonary bypass between January 1990 and April 1998. Nine patients had isolated valvular lesions [(mitral incompetence (MI)=7, aortic incompetence (AI)=1, tricuspid incompetence (TI)=1)]. The remaining 274 patients had multiple valvular disease and other pathologies (MI=158, TI=26, AI=11, MI+TI=12). The choice of valvuloplasty depended on the anatomical variation of the lesions and included leaflet resection and repair, annulus remodelling, choral shortening, transferral etc. Results There were 8 early deaths (2.8%) including three from heart failure, two from severe sepsis, two from pulmonary hypertension and one from coma. No late death was encountered in the 38 months follow up (range=2～90 months).Conclusions Conclusion: Good result is expected in operative valvuloplasty in preschool children.