Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Murakami H, Tei T, Ogawa K
Departments of Cardiothoracic Surgery and Cardiology, Kobe Children's Hospital, Kobe, Japan.
J Thorac Cardiovasc Surg. 1999 Jul;118(1):99-106. doi: 10.1016/S0022-5223(99)70148-0.
We reviewed a 20-year experience with the surgical treatment of mitral valve disease in the pediatric age group at our institution with 2 objectives: to clarify the long-term results over the last 2 decades and to evaluate the recent advances in mitral valve operation in children.
Since December 1978, 56 patients have undergone a total of 36 mitral valve repairs and 30 mitral valve replacements. Associated cardiac anomalies were present in 46 patients (82%), and concurrent repair of associated lesions was performed in 37 patients (66%). The age of the patients ranged from 3 months to 15 years (mean, 3.6 years) at mitral valve repair, and ranged from 2 months to 16 years (mean, 5.7 years) at mitral valve replacement. Mean follow-up period was 92.0 months (range, 1-235 months).
There were 2 hospital deaths and 2 late deaths in patients who underwent mitral valve repair. Reoperation was performed in 4 patients. Three of these patients underwent mitral valve replacement because of residual mitral incompetence. No hospital deaths occurred in patients who underwent mitral valve replacement. Two late deaths occurred after mitral valve replacement. Six patients had a total of 10 episodes of prosthetic valve thrombosis. Thrombolytic therapy with urokinase was successful in all episodes without serious complications. Five patients required reoperations 49 to 141 months (mean, 78.4 months) after the initial valve replacement for relative prosthetic valve obstruction as the result of somatic growth. A valve 2 or 3 sizes larger than the original prostheses was inserted without death. Actuarial survival and freedom from cardiac events at 10 years after the operation were 87.2% and 72.7% in children who underwent mitral valve repair, and 90.3% and 67.3% for those children who underwent mitral valve replacement.
The current risk of mitral valve operation in the pediatric age group is low, and the long-term results are satisfactory, irrespective of severe deformation of the mitral valve apparatus and associated complex cardiac anomalies.
我们回顾了本机构20年来小儿年龄组二尖瓣疾病的外科治疗经验，有两个目的：明确过去20年的长期结果，并评估儿童二尖瓣手术的近期进展。
自1978年12月以来，56例患者共接受了36次二尖瓣修复和30次二尖瓣置换。46例患者（82%）存在相关心脏异常，37例患者（66%）同时进行了相关病变的修复。二尖瓣修复时患者年龄为3个月至15岁（平均3.6岁），二尖瓣置换时年龄为2个月至16岁（平均5.7岁）。平均随访期为92.0个月（范围1 - 235个月）。
二尖瓣修复患者中有2例住院死亡和2例晚期死亡。4例患者进行了再次手术。其中3例患者因二尖瓣反流残留而接受二尖瓣置换。二尖瓣置换患者无住院死亡。二尖瓣置换后发生2例晚期死亡。6例患者共发生10次人工瓣膜血栓形成。尿激酶溶栓治疗在所有病例中均成功，无严重并发症。5例患者在初次瓣膜置换后49至141个月（平均78.4个月）因身体生长导致相对人工瓣膜梗阻而需要再次手术。植入比原假体大2或3个尺寸的瓣膜，无死亡发生。二尖瓣修复儿童术后10年的精算生存率和无心脏事件生存率分别为87.2%和72.7%，二尖瓣置换儿童分别为90.3%和67.3%。
小儿年龄组二尖瓣手术的当前风险较低，长期结果令人满意，无论二尖瓣装置严重变形及相关复杂心脏异常情况如何。
