4个月至6岁儿童心脏瓣膜成形术199例临床分析

Clinical analysis of surgical valvuloplasty in 199 children aged 4 months to 6 years

目的 总结 4个月至 6岁儿童房室瓣、主动脉瓣成形术的临床经验。方法 对 1990年 1月至 2 0 0 1年 12月间 ,199例 4个月～ 6岁 ,平均 (2 94± 1 5 0 )岁病儿瓣膜成形术进行回顾性分析。其中男 10 4例 ,女 95例 ;体重 3 1～ 2 1 0kg ,平均 (11 7± 3 4 )kg ,81例≤ 10kg ;其中≤ 1岁者 16例 ,≤ 3岁 12 5例。全组均为先天性瓣膜畸形 ,包括 :单纯瓣膜病变 2 1例 ,其中二尖瓣关闭不全 (MI) 7例、三尖瓣关闭不全 (TI) 6例、主动脉瓣关闭不全 (AI) 1例 ,主动脉瓣狭窄 (AS) 1例 ,MI并TI 2例 ,MI并AI 2例 ,MI并AS 1例 ,MI并二尖瓣狭窄 1例 ;合并其他心内畸形 178例 ,其中MI 12 2例 ,TI 2 6例、AI 9例、三尖瓣狭窄 2例、AS 2例、MI并TI13例 ,MI并AI 2例 ,MI并AS 2例。主要合并心内畸形包括 :室间隔缺损 12 7例、II孔房间隔缺损 31例、动脉导管未闭 30例、永存左上腔静脉 6例、法洛四联症 3例、三房心 2例、法洛三联症 2例、肺动脉闭锁 3例 ,其他 3例 ;90例合并肺动脉高压。瓣膜成形术同时矫治心内其他畸形。结果 术后早期死亡 4例 ,均为体重≤ 10kg ,心胸比率≥ 0 7者 ,死亡率 2 0 1%。死亡原因为低心输出量综合征 2例 ,严重肺部感染及肺动脉高压危象各 1例。 16 3例 (82 % )随访 2个月～ 8年 ,平均 4

Objective: To review the experience of valvuloplasty in children aged 4 months to 6 years. Methods: 199 children aged 4 months to 6 years (mean age, 2.94 years) and weight 3.1 kg to 22.0 kg (mean, 11.7 kg) underwent valvuloplasty under CPB from January 1990 to December 2001. 21 patients with isolated valvular lesions mitral incompetence(MI) in 7, tricuspid incompetence(TI) in 6, aortic incompetence(AI) in 1, aortic stenosis(AS) in 1, MI and TI in 2, MI and AI in 2, MI and AS in 1,MI and mitral stenosis in 1, the remain 178 patients had valvular disease with other pathologies (MI=122, TI=26, AI=9, MI+TI=13, tricuspid stenosis=2, AS=2, MI and AI=2, MI+AS=2). The procedures of valvuloplasty included leaflet resection and repair, annulus remodeling, choral shortening, transferal etc. depended on the anatomical variation of the lesions. Associated cardiac anomalies were corrected simultaneous. Results: There were 4 early deaths (2.0%) including 2 heart failure, 1 severe infection and 1 pulmonary hypertension. No late death was encountered during the period of 4.7 years (range 2 months-8 years) follow-up. Conclusion: Good result may be expected in valvuloplasty in children aged 4 months to 6 years.