应用自体心包二尖瓣成形术治疗小儿二尖瓣关闭不全

Improvement of autoiogous pericardium mitral annuloplasty in treatment of mitral regurgitation.

目的探讨应用自体心包的改良二尖瓣成形术治疗小儿二尖瓣关闭不全的手术经验及临床效果。方法回顾性分析2005年1月至2012年1月我们收治的32例二尖瓣关闭不全患儿临床资料，年龄1～17岁，平均年龄（8．12±7．05）岁；单纯二尖瓣关闭不全14例，合并其他心血管畸形18例。其中中度二尖瓣关闭不全15例，重度17例。二尖瓣脱垂2例，瓣叶裂24例，二尖瓣环扩大32例。患儿均在全麻中低温体外循环下采用自体心包行改良二尖瓣成形术，同时矫正合并心血管畸形；术中均采用经左心室注水试验、心脏复跳后再次检查及停体外循环后测左房压等一系列方法评价成形效果。结果全组无一例手术死亡；术后早期死亡1例，于术后第2天死于低心排出量综合征。31例痊愈出院，完整随访28例，时间6～72个月，平均（42．10±9．50）个月。术后6个月超声心动图复查提示二尖瓣中度反流2例，心功能Ⅱ级，于术后1年再次行二尖瓣成形术。随访期间无死亡病例。除2例再次手术患儿外，其余获访患儿NYHA心功能评级均保持在I级，5年生存率96．8％，再手术率6．25％。结论应用自体心包的改良二尖瓣成形术治疗小儿尖瓣关闭不全具有预防后瓣环扩张和保留前瓣叶及其瓣环部分生长潜力的优点，同时能够保证二尖瓣开口的柔软性，再手术率相对较低，可获得良好疗效。

Objetive Explore the application of autologous pericardium improved plastic surgery for mi- tral valve of children experience and clinical effect. Methods A retrospective analysis 32 cases of mitral re- gurgitation in pediatric patients from January 2005 to January 2012, mean age 8.12 ±7.05 （ 1 - 17 years） , pure mitral regurgitation in 14 cases, combined with other cardiovascular malformation in 18 cases. Mitral valve insufficiency moderate 15 cases , severe 17 cases. All patients were in general anesthesia under hypothermic cardiopulmonary bypass, using autologous pericardium valve ring constriction operation, leaflet cleft repair, af- ter the flap is rectangular or triangular resection arthroplasty and mitral annuloplasty techniques, at the same time correction of cardiovascular malformations ; Intraoperative adopt by left ventricular after water injection test, the heart jump again check and stop after extracorporeal circulation test and a series of methods to evaluate left atrial pressure forming effect. Results There were no death in operating. Early postoperative death in 1 cases, postoperative day second died of low cardiac output syndrome. 31 cases were cured, 28 cases with complete fol- low - up, time of 6 - 72 months, an average of （42.10 -＋ 9.50） months. 6 months after echocardiography icon moderate mitral regurgitation two cases, heart function [[ after 1 year again underwent mitral valvuloplasty. Ex- cept 2 cases of reoperation, the won ＂s visit to the patients with NYHA heart function remained in I rating class, children with 5-year survival rate was 96.8%, reoperation rate was 6.25%. Conclusions Application of autologous pericardium modified mitral valvuloplasty in treatment of pediatric mitral regurgitation with proph- ylaxis after dilated tricuspid annulus and retention of the first valve and valve ring part growth potential advanta- ges, at the same time to ensure that the mitral orifice softness, again operation rate is relatively low, can achieve good results.