三尖瓣前瓣扩大技术在儿童再次三尖瓣成形中的应用

Leaflet extension in reoperation after tricuspid valve repair in children

目的总结三尖瓣前瓣扩大技术在15岁及以下儿童再次三尖瓣手术中的应用经验,初步探讨三尖瓣前瓣扩大技术的应用指征、手术技巧等相关问题。方法回顾性分析2006年1月至2015年10月上海交通大学医学院附属新华医院再次三尖瓣成形术中行三尖瓣前瓣扩大技术的23例患儿的临床资料,其中男15例、女8例,平均年龄8.7(5~15)岁。术中使用人工心包补片扩大三尖瓣前瓣叶。术后以华法林抗凝治疗,维持国际标准化比值(INR)在2.0~3.0。结果全组患儿体外循环时间87~132(98.5±35.7)min,主动脉阻断时间56~97(68.40±23.78)min。院内死亡1例,术后出现并发症3例,其中呼吸衰竭、肾功能不全、右心功能不全各1例,均经治疗后痊愈。随访5个月~10年,平均3.5年,随访期间死亡1例,有6例患儿出现轻-中度三尖瓣关闭不全,其余患儿三尖瓣功能良好,无再次手术,无抗凝相关并发症。结论对于需要再次行三尖瓣手术的患儿应用三尖瓣前瓣扩大技术,围术期及术后密切治疗,能取得良好的近中期疗效。

Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years,ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132（98.5±35.7） minutes, and average aortic cross-clamping time was 56-97（68.40±23.78） minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.