4个月至6岁儿童心脏瓣膜成形术199例临床分析.docVIP

4个月至6岁儿童心脏瓣膜成形术199例临床分析 中华胸心血管外科杂志2004年2月第20卷箍1塑ChinJThoracCardiovascSurg,February2004,Vo1.20No.1 4个月至6岁儿童心脏瓣膜成形术 199例临床分析 刘迎龙朱晓东于存涛沈向东闫军李守军 【摘要】目的总结4个月至6岁儿童房室瓣,主动脉瓣成形术的f临床经验.方法对1990年1 月至2001年12月间,199例4个月～6岁,平均(2.94±1.50)岁病儿瓣膜成形术进行回顾性分析.其中 男104例,女95例;体重3.1～21.0kg,平均(11.7±3.4)kg,81例≤10kg;其中≤1岁者16例,≤3岁125 例.全组均为先天性瓣膜畸形,包括:单纯瓣膜病变21例,其中二尖瓣关闭不全(MI)7例,三尖瓣关闭不 全(TU6例,主动脉瓣关闭不全(AI)1例,主动脉瓣狭窄(AS)1例,MI并112例,MI并AI2例,MI并AS1 例,MI并二尖瓣狭窄1例;合并其他心内畸形178例,其中MI122例,Ⅱ26例,AI9例,三尖瓣狭窄2例, AS2例,MI并盯13例,MI并AI2例,MI并AS2例.主要合并心内畸形包括:室间隔缺损127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2.01%.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.163例(82%)随访2个月～8年,平均4.7年,无远期死亡, 心脏明显缩小.结论4个月至6岁病儿心脏瓣膜病变采用瓣膜成形术能取得理想的早期和远期疗效. 【关键词】心脏瓣膜疾病心脏外科手术瓣膜成形术儿童 Clmiealanalysisofsurgi~valvuloplastyin199childrenaged4monthsto6yearsLIUYing-long,ZHUXiao-dong,YUCan- tao,eto1.CardiovascularInstituteandFuWaiHospital,CAMSamp;PUMC,Beijing100037,China 【Abstract】Objective:Toreviewtheexperienceofvalvuloplastyinchildrenaged4monthsto6years.Methods:199children aged4monthsto6years(meanage,2.94years)andwelght3.1kgto22.0kg(mean,11.7kg)underwentvalvuloplastyunamp;rCPB fromJanuary1990toDecember2001,21patientswithisolatedvalvularlesionsmitralincompetence(MI)in7,tricuspidincompetence (TI)in6,aorticincompetence(AI)in1,aorticstenosis(AS)in1,MIandTIin2,MIandAIin2,MIandASin1,MIandmitral stenosisin1,theremain178patientshadvalvulardiseasewithotherpatholagles(MI=122,TI=26,AI=9,MI+TI=13,tricus— pidstenosis=2,AS=2,MIandAI=2,MI+AS=2).Theproceduresofvalvuloplastyincludedleafletresectionandrepair,annu— lusremodeling,choralshortening,transferaletc.dependedontheanatomicalvariationofthelesions.Associatedcardiacanonudies werecorrectedsimultaneous.Results:Therewere4earlydeaths(2.0%)including2heartfailure,1severeinfectionand1pulmo— naryhypertension.Nolatedeathwasencounteredduringtheperiodof4.7years(range2months～8years)follow—up.Conclusion: Goodresultmaybeexpectedinvalvuloplastyinchildren