CAJ | 학술논문

目的总结5岁以下二尖瓣病变患儿行二尖瓣置换手术的治疗经验.方法 2008年1月至2011年12月,共12例5岁以下的二尖瓣病变患儿进行二尖瓣置换手术.其中男9例,女3例;年龄4～58个月,平均(26.2±18.1)个月;体质量5.6 ～13.0 kg,平均(9.6±3.8) kg.患儿有中度以上二尖瓣反流或(和)明显的二尖瓣狭窄,均伴有明显的心功能衰竭.3例为二尖瓣成形术后再行二尖瓣置换术.均置入机械瓣膜,9例采用17 ～ 23号主动脉瓣反向置入,3例采用25～27号二尖瓣正向置入.结果手术死亡1例(8.3％).术后心律失常2例,轻度溶血2例,经治疗均恢复正常.11例生存患儿心功能改善明显,未出现出血和血栓形成等异常情况.结论严重二尖瓣病变对小年龄儿童的心功能影响极大,尽早手术干预是惟一的选择,二尖瓣置换术是二尖瓣成形手术效果不佳患儿的最后选择.采用型号相对较小的主动脉瓣倒置置入二尖瓣环内,基本解决了机械瓣瓣膜-患者不匹配的问题,但置入小型号机械瓣的患儿再次行二尖瓣置换术的可能较大;小年龄儿童有良好的抗凝依从性,但需加强监测抗凝指标,以防发生出血和栓塞.
목적 총결5세이하이첨판병변환인행이첨판치환수술적치료경험.방법 2008년1월지2011년12월,공12례5세이하적이첨판병변환인진행이첨판치환수술.기중남9례,녀3례;년령4～58개월,평균(26.2±18.1)개월;체질량5.6 ～13.0 kg,평균(9.6±3.8) kg.환인유중도이상이첨판반류혹(화)명현적이첨판협착,균반유명현적심공능쇠갈.3례위이첨판성형술후재행이첨판치환술.균치입궤계판막,9례채용17 ～ 23호주동맥판반향치입,3례채용25～27호이첨판정향치입.결과 수술사망1례(8.3％).술후심률실상2례,경도용혈2례,경치료균회복정상.11례생존환인심공능개선명현,미출현출혈화혈전형성등이상정황.결론 엄중이첨판병변대소년령인동적심공능영향겁대,진조수술간예시유일적선택,이첨판치환술시이첨판성형수술효과불가환인적최후선택.채용형호상대교소적주동맥판도치치입이첨판배내,기본해결료궤계판판막-환자불필배적문제,단치입소형호궤계판적환인재차행이첨판치환술적가능교대;소년령인동유량호적항응의종성,단수가강감측항응지표,이방발생출혈화전새.
Objective To review and summarize the experiences of mitral valve replacement in the children aged less than five years.Methods Twelve patients with moderate to severe mitral valve regurgitation (MR) or/and severe mitral valve stenosis (MS) were retrospectively study from January 2008 to December 2011,all of them suffered from severe heart failure and underwent mechanical mitral valve replacement.There were 9 males and 3 females.They aged from 4 to 58 months [mean (26.2 ± 18.1) months] and weighted from 5.6 to 13.0 kg [mean (9.6 ± 3.8) kg].Three patients underwent unsuccessful mitral valve repair before mitral valve replacement.17 to 23 mm aortic bileaflet mechanical prosthesis were reverse directional implanted in nine patients and 25 to 27 mm mitral bileaflet mechanical prosthesis were implanted in three patients.Results One patient died,the operative mortality rate was 8.3％.2 patients were complicated by cardiac arrhythmia and 2 patients complicated by mild hemolysis,all recovered after symptomatic treatment.The heart function of servived 11 patients improved significantly,none of them were complicated by haemorrhage or thromboembolic.Conclusion Severe mitral valve lesion injure heart function significantly for the young children and timely surgical intervention is the only option.Mitral valve replacement is the ultimate option for the patients failed in mitral valve annuloplasty.The introduction of aortic bileaflet mechanical prosthesis which smaller size is available and reverse directional implantation resolve the difficulty of prosthesis-patient mismatch essentially,most children with a small prosthesis has to redo mitral valve replacement with a larger size prosthesis.The compliance of permanent anticoagulation of young children is favourable and more intensively follow-up is essential to avoid the incidence of bleeding and thromboembolic.