儿童主动脉瓣置换术临床特点及中远期随访结果

Mechanical aortic valve replacement in children and the mid-long term follow-up

目的 总结15岁以下儿童主动脉瓣置换术的临床特点及中远期随访结果,探讨手术指征、瓣膜选择等相关问题.方法 回顾性分析2006年1月至2014年1月上海交通大学医学院附属新华医院15岁以下29例行瓣膜置换患者临床资料.其中男性19例,女性10例,年龄2～15（10.66±3.55）岁.病因：先天性主动脉瓣发育异常24例,感染性心内膜炎5例.手术均在中度低温体外循环下进行,其中主动脉瓣置换22例、主动脉瓣二尖瓣双瓣置换术7例,均采用机械瓣膜.所有瓣膜置换均采用间断褥式缝合方法,术中采用Manouguian法行主动脉根部加宽5例;术后使用主动脉内球囊反搏（IABP）辅助2例.术后以华法林抗凝治疗,维持INR在2.0～3.0.结果 患者CPB时间（126.39±68.44）min,主动脉阻断时间（77.39±48.23）min.全组院内死亡1例.术后出现并发症3例,其中心律失常1例（窦性心动过缓、阵发性房室传导阻滞）,呼吸衰竭l例,急性肾衰竭1例,均经治疗后痊愈.随访1个月至8年,平均3.5年,随访期无死亡,所有患者机械瓣功能均良好,无再次手术,无抗凝相关并发症.结论 对于儿童主动脉瓣疾病患者,选择合适的手术时机进行主动脉瓣置换术,围术期及术后密切治疗,近期及中远期疗效均良好.

Objective To summarize the clinical characteristics and mid-long term efficacy of mechanical aortic valve replacement in children who under 15 year-old. Methods From Jau.2006 to Jau. 2014, 29 children, aged 2 to 15 year-old underwent mechanical valve replacement in Xinhua Hospital, School of Medicine, Shanghai Jiaotong University. There were 19 males and 10 females with mean age of （10.66±3.55）years old. All operations were practiced with cardiopulmonary bypass with mid-low temperature, including 22 cases with aortic valve re- placement, 7 cases with double valve replacement. The mechanical prosthesis was chosen with interrupted mattress sutures to replace the sick valve. The Manougian procedure was utilized to enlarge aortic valve annular in 5 cases. Two cases got intra-acrtic balloon pump after operation. All the patients have got warfarin as anticoagulant therapy and the international normalized ratio have been maintained between 1.8 to 2.5. Results The average CPB time was （126.39±68.44）minutes, and average aortic cross-clamping time was （77.39±48.23）minutes. One patient died in hospital. Three cases had complications, including malignant ventricular arrhythmia （1 case）, respiratory failure （1 case） and acute renal failure （1 case）. All of the children were cured. Time of 1-96 months follow-up was made for the 28 children. No children died during the follow-up period. No other redo-valve replacement. No com- plications correlated to anticoagulant. Conclusion Mechanical aortic valve replacement might be necessary in children with the appropriate selection of the prosthetic valve and intensive care therapy during the peroperative pc-riod, the mid-long eftlcacy is optimistic.