瓣膜成形术治疗婴幼儿中重度先天性二尖瓣闭锁不全及其疗效分析

Valve repair of congenital mitral regurgitation in infants and young children

目的 总结婴幼儿中、重度先天性二尖瓣关闭不全 (MI)成形术的经验并探讨影响疗效的相关因素。 方法 38例中、重度MI患者 ,其中单纯MI 5例 ,合并心内其他畸形 33例。本组患者平均年龄 (2 3± 1 2 )岁 ,<1 0岁的 5例 ;体重 (1 2 6± 3 9)kg ,<1 0 0kg的 1 3例 ,均在中低温体外循环下行二尖瓣成形和心内其他畸形矫治。术中根据二尖瓣病理变化的不同分别采用交界缝缩、部分瓣环环缩、瓣叶裂缺修补、腱索缩短和转移、人工腱索、后瓣成形等方法恢复二尖瓣功能 ,必要时可多种方法同时应用。 结果 本组患儿术后无一例死亡 ,无严重并发症 ;随访 2个月～ 6年 ,平均 (30±1 0 )个月。 1 1例二尖瓣反流消失 ,2 2例轻度反流 ,3例中度反流 ,2例中～重度反流 ;37例无临床症状 ,心功能Ⅰ级 ,1例心功能Ⅱ～Ⅲ级 ,需内科药物辅助。 结论 瓣膜成形术治疗婴幼儿先天性二尖瓣关闭不全可取得满意的早、中期效果 ;年龄和合并畸形不再是影响手术成败和术后疗效的主要因素。

Objective To summarize the experience of mitral valve(MV) repair in infants and young children with congenital mitral malformation. Methods Thirty eight consecutive infants and young children with this disease, aged (2 3±1 2) years,weighted (12 6±3 9) kg, underwent mitral repair from January 1996 to March 2002. The procedure included partial annuloplasty, repair of the cleft of the mitral leaflet, chordal shortening, chordal transfer, artificial chordae and reconstruction of the posterior leaflet. The modified annuloplasty allows natural growth of the annulus. The associated cardiac anomalies were totally corrected. Results In these patients, no early and late deaths were observed, nor reoperation and severe complications. No or trivial regurgitation occurred in 11 patients, mild regurgitation in 22, and moderate and greater regurgitation in 5. Thirty seven patients were asymptomatic. Conclusions Mitral repair procedure may be effective in infants and children with early or intermediate mitral regurgitation.