儿童心脏瓣膜置换术(15例临床分析)

Valve Replacement in Children (Report of 15 Cases)

目的 总结 1982年 3月至 2 0 0 2年 3月 15例儿童心脏瓣膜置换术的经验 ,探讨儿童瓣膜置换的手术指征、瓣膜选择、手术技术和术后抗凝治疗等问题。方法 全组 15例中 11例为先天性病变。在中低温体外循环下手术 ,二尖瓣置换 10例 ,主动脉瓣置换 3例 ,三尖瓣置换 1例 ,双瓣置换 1例。均采用机械瓣。手术同期矫正其他先天性畸形。术后常规应用华法令抗凝。结果 无手术及住院死亡。随访 1月～ 2 0年 ,晚期死亡 2例 ,其余病人心功能均为I级 ,无心律失常 ,未发现有感染、出血或血栓等并发症 ,瓣膜功能良好。结论 儿童心脏瓣膜置换术采用机械瓣效果良好 ,术后抗凝治疗应个体化 。

Purpose: To review our twenty-year experience with valve replacement in children. Methods: From March 1982 to March 2002, 15 patients aged 7 - 15 years underwent valve replacement with mechanical prostheses in our hospital. Of the 15 patients, 11 had congenital valve lesion. Operation was performed under moderate hypothermic cardiopulmonary bypass. Mitral valve replacement was performed in 10 patients, aortic valve in 3, tricuspid in 1, double valve in 1. Concomitant cardiac defects were corrected simultaneously. Postoperative anticoagulation was achieved by warfarin. Results: There were no hospital deaths and surgical deaths. The follow-up was done from 1 month to 20 years. All the patients survived had a NYHA class I. Of the survival there were no arrhythmia, intracardiac infection, bleeding, thromboenbolism or prosthesis dysfunction during the follow-up period. Conclusions: Valve replacement with mechanical prostheses can be performed with good outcome in children. Postoperative anticoagulation should be individualized. Long term anticoagulation with lower level is safe and acceptable in children.