单个主动脉瓣叶牛心包置换术治疗儿童室间隔缺损合并主动脉瓣反流

Single Aortic Cusp Replacement with Bovine Pericardium for Children with Ventricular Septal Defect and Aortic Regurgitation

目的 探讨儿童单个主动脉瓣叶牛心包置换在室间隔缺损合并严重主动脉瓣反流患儿中的疗效。 方法回顾性分析2006年3月至2009年9月武汉亚洲心脏病医院室间隔缺损合并严重主动脉瓣关闭不全42例患儿行单个主动脉瓣叶牛心包置换术的临床资料。其中男28例、女14例，平均年龄2～14 （9.0±3.6） 岁。所有心功能分级（NYHA）均为Ⅱ级。 结果 手术没有死亡以及并发症的发生。术后即刻经食管超声心动图提示手术成功修复主动脉瓣，瓣叶均对合正常。所有患者主动脉瓣反流均在轻度以内，跨主动脉瓣峰压差为（14.2±2.8） mm Hg。住院时间11 d，没有任何不良症状。全组患者随访32～72 （50±16） 个月。术后心功能均为Ⅰ级，无反流17例，轻度反流21例，中度反流4例。跨主动脉瓣峰压差为（12.4±3.2） mm Hg。随访中无死亡和需要二次手术患者。随访观察中未见牛心包瓣叶结构性衰败。 结论 对于室间隔缺损合并重度主动脉瓣关闭不全的患者，单个主动脉瓣叶牛心包置换术具有良好的血流动力学和中期效果。

Objective To assess clinical results of single aortic cusp replacement with bovine pericardium fochildren with ventricular septal defect （VSD） and severe aortic regurgitation （AR）. Methods Clinical data of 42 childrenwith VSD and severe AR who underwent single aortic cusp replacement with bovine pericardium in Wuhan Asia Heart Hospital from March 2006 to September 2009 were retrospectively analyzed. There were 28 male and 14 female patients with their age of 2-14 （9.0±3.6） years. All the patients were in NYHA classⅡ. Results No early mortality or major morbidity was recorded. Intraoperative transesophageal echocardiography showed successful repair with normal coaptationof the aortic leaflets in all the patients. AR grade was less than mild in all the patients with peak aortic valve pressure gradientsof 14.2±2.8 mm Hg. All the patients were discharged from the hospital within 11 postoperative days without any adverse symptom,and were followed up for 32-72 （50±16） months. During follow-up,all the patients were in NYHA class I. Therewere 17 patients without AR,21 patients with mild AR and 4 patients with moderate AR. The peak aortic valve pressuregradient was 12.4±3.2 mm Hg. None of the patients died or required reoperation,and structural valve degeneration was not observed during follow-up. Conclusion Single aortic cusp replacement with bovine pericardium can produce good hemodynamics and midterm results for children with VSD and severe AR.