儿童主动脉瓣疾病手术治疗进展

Progress of surgical treatment for aortic valve diseases in children

儿童主动脉瓣狭窄的首选治疗方法目前仍有争议。主动脉瓣切开术和球囊主动脉瓣成形术早期疗效相仿，但前者中远期免于再干预率明显优于后者。主动脉瓣修复是目前学界的关注重点．瓣叶延长、瓣叶置换或瓣膜重建为原本无法修复的病变提供了治疗机会。Ozaki技术采用戊二醛处理的自体心包进行一个或多个瓣叶的置换，测量工具和裁剪模板的使用提高了该技术的标准化程度和可复制性，易于推广应用。自体肺动脉瓣移植具有良好的术后血流动力学表现和较低的再手术率，效果优于其他瓣膜置换术。机械瓣置换需终身抗凝治疗，具有较高的再干预率：生物瓣置换由于其早期钙化失功率较高．已很少用于儿童患者。

As the primary treatment of aortic valve stenosis in children, surgical aortic valvotomy （SAV） and balloon aortic valvuloplasty （BAV） are widely used. With the similar early curative effect to BAV, SAV performs better in long-term follow-up. But the first choice for aortic valve stenosis is still controversial. These years, aortic valve repair is valued and different repair techniques have been reported and achieved good results. The complex repair techniques, as leaflet extension, leaflet replacement or valve reconstruction, are effective in treating diseased valves that cannot be repaired before. Ozaki technology, using glutaraldehyde-treated autologous pericardium to replace the aortic valve, makes the surgery more standardized and reproducible by developing special instruments. Pulmonary autograft （ Ross procedure ） is considered to be superior to other valve replacement technologies due to the good hemodynamic performance and lower reoperation rate. Mechanical valve is still used in some cases, but the quality of life is low due to the lifelong anticoagulation, and it has a high reintervention rate. The biological valve has been rarely used in children because of its high rate of early calcification and structural failure.