Ben-Ismail M, Kafsi N, Taktak M
Arch Mal Coeur Vaiss. 1978 Oct;71(10):1090-8.
We report 100 cases of mitral commissurotomy in children, 15-years-old or less, suffering from rheumatic mitral stenosis. Mitral stenosis in children is characterised by the severity of functional impairment and the considerable radiological, electocardiological and haemodynamic changes, with pulmonary arterial hypertension which is always present and often well marked. The early results of mitral commissurotomy are very satisfactory with clinical improvement and a low mortality. But, in the long term, we have seen progressive deterioration in the clinical state of these patients resulting from re-stenosis or from the progression of another valve lesion. Three problems have been discussed. First, the progression of the rheumatic process which seems to account to a large extent for the late failures of mitral commissurotomy in children. Secondly, the problem of tricuspid insufficiency, which is often associated with mitral stenosis in childhood and which usually disappears during the post-operative period. Finally, the problem of pre-capillary pulmonary arterial hypertension which always showed a tendency towards regression.
我们报告了100例15岁及以下患有风湿性二尖瓣狭窄的儿童二尖瓣交界切开术病例。儿童二尖瓣狭窄的特点是功能损害严重，伴有显著的放射学、心电图和血流动力学改变，肺动脉高压总是存在且常常很明显。二尖瓣交界切开术的早期结果非常令人满意，临床症状改善且死亡率低。但是，从长期来看，我们发现这些患者的临床状况因再狭窄或另一种瓣膜病变的进展而逐渐恶化。讨论了三个问题。第一，风湿过程的进展，这似乎在很大程度上导致了儿童二尖瓣交界切开术的晚期失败。第二，三尖瓣关闭不全的问题，这在儿童时期常与二尖瓣狭窄相关，且通常在术后消失。最后，毛细血管前肺动脉高压的问题，其总是有消退的趋势。
