瓣叶折叠在小儿二尖瓣成形中的应用

Leaflet foldoplasty of mitral valvuloplasty for mitral regurgitation in children

目的提供一种基于儿童先天性二尖瓣反流(mitral regurgitation,MR)解剖异常特点的,相对简单化、可重复性高的标准化二尖瓣成形(mitral valvuloplasty,MVP)策略,并报道单中心的近期结果。方法回顾性分析2016~2018年在本中心接受标准化MVP策略手术74例患者的临床资料,其中男30例、女44例,中位年龄18.5(6~146)个月,中位体重15.4(7~51)kg。结果二尖瓣畸形包括:(1)瓣下水平:72例(97.3%)腱索异常连接,31例(41.9%)腱索缺失,14例(18.9%)乳头肌融合或发育不全;(2)瓣叶水平:10例(13.5%)前叶裂,61例(82.4%)瓣叶脱垂,其中56例(91.8%)为前叶脱垂;(3)瓣环水平:71例(95.9%)瓣环扩张。61例(82.4%)瓣叶脱垂均进行了瓣叶折叠。所有患者均顺利出院,4例(5.4%)患者为中量MR。中位随访时间22.0(9.1~41.8)个月,随访期间无患者死亡,4例(5.4%)患者发生中量或以上MR,均为术后即中量MR患者,其中1例患者由中量MR进展为大量MR,并行MVP再手术。患者整体心功能良好,平均左室射血分数66.0%±6.1%。平均左室舒张末期直径(31.8±6.0)mm,较术前明显减小(t=6.090,P<0.0001)。结论基于瓣叶折叠理念并辅以异常腱索处理和后瓣环环缩的MVP标准化术式近期预后良好,是一种安全可行的治疗先天性MR的MVP策略。

Objective To report the short-term outcomes of a standardized,simplified and reproducible strategy of mitral valvuloplasty(MVP),which was focused on leaflet foldoplasty and anatomic anomalies of congenital mitral regurgitation(MR).Methods Consecutive 74 patients who underwent MVP by our standardized strategy in our institution from 2016 to 2018 were included retrospectively.There were 30 males and 44 females with a median age of 18.5(6-146)months and weight of 15.4(7-51)kg.Results Anatomic anomalies of MR included:(1)subvalvular apparatus:72(97.3%)patients with mal-connected chordae tendineae,31(41.9%)with absent chordae tendineae and 14(18.9%)with fused or dysplastic papillary muscle;(2)leaflet:10(13.5%)patients with cleft of anterior leaflet,61(82.4%)with leaflet prolapse including 56(91.8%)with anterior leaflet prolapse;(3)annulus:71(95.9%)patients with annular dilatation.Leaflet foldoplasty was performed in 61(82.4%)patients with leaflet prolapse.All patients were successfully discharged and 4(5.4%)patients were with moderate MR.The follow-up time was 22.0(9.1-41.8)months.During the follow-up period,3 patients had moderate MR and 1 patient had reoperation for severe MR.All patients were in normal cardiac function with a mean left ventricular ejection fraction of 66.0%±6.1%.In addition,the mean left ventricular end-diastolic dimension was 31.8±6.0 mm,which was significant smaller than that before the operation(t=6.090,P<0.0001).Conclusion The standardized leaflet foldoplasty with resection of mal-connected chordae tendineae and posterior annuloplasty technique is safe and feasible with favorable short-term outcomes in MR patients.