婴幼儿二尖瓣整形术104例的临床疗效及短期随访报告

Clinical efficacy and short-term follow-up report on mitral valve plasty in infants : a study of 104 cases

目的了解先天性心脏病并存或仅存中-重度二尖瓣反流的婴幼儿二尖瓣整形术后的早期临床疗效及随访情况。方法回顾性分析广东省人民医院104例行先天性心脏病矫正,同时行二尖瓣整形术的婴幼儿,男53例,女51例;中位年龄8（12~24）个月,范围1~57个月;中位体质量为7.0（5.50~8.88）kg,范围3.80~15.5 kg;中位身高为68（63~75）cm,范围52~111cm。术前纽约心脏协会（New York Heart Association,NYHA）心功能：Ⅰ级1例（1%）,Ⅱ级75例（72.1%）,Ⅲ级25例（24%）,Ⅳ级3例（2.9%）。随访二尖瓣整形术前、后患儿临床表现、心功能、超声心动图表现;采用随机区组方差分析检验超声心动图随访结果。结果术后1例因低心排血量综合征死亡,手术成功率99%。术后并发症发生率为8.7%。中位住院时间19（13~23.75）d,范围6~54 d。超声心动图随访左心房内径、左心室舒张末及收缩末内径、左心室射血分数、二尖瓣反流面积均比术前明显减小,差异有统计学意义（P〈0.05）;组间比较显示,术后3个月上述指标与术前比较,差异有统计学意义（P〈0.05）。结论对先天性心脏病并存或仅存中-重度二尖瓣反流的婴幼儿患者,二尖瓣整形术在临床值得推广,早期手术效果满意,无需抗凝治疗,可提高患儿生活质量。

Objectives To investigate the early clinical results of infants undergoing mitral valve repair. Methods From2009 to 2013, 104 infants [53 males and 51 females; median age ： 8（12-24） months, ranging from 1-57 months;median weight ：7.0（5.50-8.88） kg, ranging from 3.80-15.5 kg; median height ： 68（63-75） cm, ranging from 52-111 cm; preoperative New York Heart Association（NYHA） heart function class ： 1 case（1%） with grade I, 75 cases（72.1%） with grade II, 25 cases（24%） with grade Ⅲ, 3 cases（2.9%） with grade Ⅳ ] received mitral valve repair in Guangdong General Hospital. Clinical manifestations of heart function in these patients before and after mitral valve repair were followed, as well as echocardiography statistics including left atrial diameter, left ventricular end-diastolic and end-systolic diameters, left ventricular ejection fraction and mitral regurgitant area. Randomized block analysis of variance test was used to analyze the echocardiography statistics. Results One patient died from low cardiac output after surgery. Surgical success rate was 99%. Incidence of postoperative complications was 8.7%. Median hospital duration was 19（13-23.75） days, ranging from 6 to 54 days. Left atrial diameter, left ventricular end-diastolic and end-systolic diameters, left ventricular ejection fraction and mitral regurgitant area after surgery significantly reduced compared with those before surgery（P〈0.05）. Differences of the indexes above were statistically significant between preoperative surgery and 3 months ＇ after surgery（P〈0.0）. Conclusions In infants with congenital cardiac diseases complicated with moderate to severe mitral regurgitation, mitral valve repair is an effective option, with satisfactory early surgical results providing better life quality.