Moran A M, Daebritz S, Keane J F, Mayer J E
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Circulation. 2000 Nov 7;102(19 Suppl 3):III160-5. doi: 10.1161/01.cir.102.suppl_3.iii-160.
Mitral regurgitation (MR) represents the principal indication for reoperation in patients after repair of atrioventricular septal defects (AVSD). Reports of mitral valvuloplasty (MVP) in such patients are few; the alternative, mitral valve replacement (MVR), necessitates commitment to future valve replacement and long-term anticoagulation. We sought to determine the outcome of those patients who underwent either MVP or MVR between January 1, 1988, and December 31, 1998, for significant MR after repair of AVSD. Furthermore, we sought to identify (a) morphological predictors necessitating MVR, and (b) predictors of future reoperation within the MVP group.
Retrospective review of clinical, operative, and echocardiographic data were performed. There were 46 patients identified (37 MVP and 9 MVR). The median age at initial AVSD repair was 0.6 years, and the age at subsequent mitral valve operation was 2.8 years. The early postoperative mortality rate was 2.2%, and survival at 1 and 10 years was 89.9% and 86.6%, respectively. A high rate of complete heart block was noted within the MVR group (37.5%). Freedom from later mitral valve reoperation for both groups was similar. No significant morphological predictors necessitating MVR were found. Predictors of reoperation within the MVP group included the presence of moderate or worse MR in the early postoperative period. In both groups New York Heart Association class, degree of MR, growth, and ventricular volumes improved.
Mitral valve surgery significantly improves clinical status, with a sustained improvement in ventricular chamber size. MR can be successfully managed in patients after repair of AVSD independent of morphological type. Overall survival is acceptable, and further reoperation within the MVP group is influenced by early outcome of repair.
二尖瓣反流（MR）是房室间隔缺损（AVSD）修复术后患者再次手术的主要指征。此类患者二尖瓣成形术（MVP）的报道较少；另一种选择二尖瓣置换术（MVR）则需要接受未来的瓣膜置换和长期抗凝治疗。我们试图确定1988年1月1日至1998年12月31日期间因AVSD修复术后严重MR而接受MVP或MVR的患者的结局。此外，我们试图确定（a）需要进行MVR的形态学预测因素，以及（b）MVP组内未来再次手术的预测因素。
对临床、手术和超声心动图数据进行回顾性分析。共确定46例患者（37例行MVP，9例行MVR）。初次AVSD修复时的中位年龄为0.6岁，随后二尖瓣手术时的年龄为2.8岁。术后早期死亡率为2.2%，1年和10年生存率分别为89.9%和86.6%。MVR组完全性心脏传导阻滞发生率较高（37.5%）。两组二尖瓣再次手术的自由度相似。未发现需要进行MVR的显著形态学预测因素。MVP组再次手术的预测因素包括术后早期存在中度或更严重的MR。两组患者的纽约心脏协会心功能分级、MR程度、生长情况和心室容积均有所改善。
二尖瓣手术显著改善临床状况，心室腔大小持续改善。AVSD修复术后患者的MR可成功处理，与形态学类型无关。总体生存率可接受，MVP组内的进一步再次手术受修复早期结果的影响。
