儿童心瓣膜置换术患者的临床特点及中远期随访

Mechanical Valve Replacement in Children and the Result of Mid-long Term Follow-up

目的总结心脏瓣膜置换术儿童的临床特点及中远期效果。方法回顾性分析2006年1月至2014年1月于上海交通大学医学院附属新华医院行心瓣膜置换术的51例患者的临床资料,其中男32例、女19例,年龄1-15（9.6±4.0）岁。结果患者体外循环时间52-303（120.50±61.02）min,主动脉阻断时间27-221（68.35±42.68）min。全组院内死亡1例（2%）。术后发生并发症6例（11.8%）：二尖瓣瓣周漏1例,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1例,急性肾功能衰竭2例,延迟关胸1例,均经治疗后痊愈;远期真菌性心内膜炎1例,经药物治疗后痊愈。随访1个月至8年,随访期间死亡1例（2.0%）,其余患者机械瓣功能均良好,无再次手术,无抗凝相关并发症。结论对于儿童心脏瓣膜病患者,如果成形失败、瓣膜损害严重及血流动力学严重受损,选择合适的手术时机进行心瓣膜置换术,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 children under 15 years with mechanical valve replacement. Methods We retrospectively analyzed the clinical data of 51 children aged 1 to 15 years underwent mechanical valve replacement in Xinhua Hospital between January 2006 and January 2014. There were 32 males and 19 females with mean age of 9.6±4.0 years（ranged 1-15 years）. Results The average cardiopulmonary bypass time was 120.50±61.02 minutes, and average aortic cross-clamping time was 68.35±42.68 minutes. One patient died in hospital. There were 6 patients（11.8%） with complications including mitral paravalvular leakage in 1 patient, malignant ventricular arrhythmia in 1 patient, respiratory failure in 1 patient, acute renal failure in 2 patients, and delayed thoracic close in 1 patient. All the children cured and were followed up for 1-96 months. One patient died during the follow-up time. No other redo-valve replacement or complications correlated to anticoagulant occurred. Conclusions Mechanical valve replacement may be necessary in children with extremely dysplastic valves and severe hemodynamic impairment or after failed repair. With appropriate selection of the prosthetic valve and intensive care therapy during the peroperative period, the mid to long term efficacy is optimistic.