Hasaniya Nahidh, Gundry Steven R, Razzouk Anees J, Mulla Neda, Bailey Leonard L
Division of Cardiothoracic Surgery, Loma Linda University Medical Center, CA 92354, USA.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):970-4. doi: 10.1016/j.jtcvs.2003.10.023.
Surgical aortic valvotomy has a long history of providing excellent palliation for aortic stenosis in infancy and childhood. The fate of aortic valve repairs for dominant aortic regurgitation in this same age group is considerably less clear.
From 1990 to 2000, a total of 21 patients underwent aortic valve repair for aortic regurgitation at our institution. Seventeen patients were younger than 17 years at the time of repair (3-17 years, mean 8.1 +/- 3.7 years). Of these 17 children, 6 (35%) had bicuspid valves and 11 (65%) had tricuspid valves. Type of repair varied with valve type, but repair generally consisted of commissure resuspension, partial commissure closure, triangular resection of redundant leaflets, or some combination.
There were no deaths. Follow-up ranged from 1 to 11 years (mean 5.3 +/- 2.4 years). At present 3 of 17 (17.6%) have mild aortic regurgitation according to echocardiography and 6 (35.2%) have moderate aortic regurgitation. In 8 of 17 cases (47.1%) the repair clearly failed, requiring reoperation from 0.5 to 73 months after the original operation (mean 18.9 months). Reoperation consisted of 6 Ross procedures and 2 mechanical aortic valve replacements. There were no deaths at the secondary operation.
Aortic valve repair in children with a dominant feature of aortic insufficiency tended to fail progressively and at a high rate. Leaflet thickening was associated with higher risk of repair failure in this series. The threshold for aortic valve replacement should remain low.
外科主动脉瓣切开术长期以来一直为婴幼儿和儿童期的主动脉瓣狭窄提供出色的姑息治疗。而在同一年龄组中，针对重度主动脉瓣反流进行主动脉瓣修复的预后则不太明确。
1990年至2000年，我院共有21例患者因主动脉瓣反流接受了主动脉瓣修复术。其中17例患者在修复时年龄小于17岁（3至17岁，平均8.1±3.7岁）。在这17名儿童中，6例（35%）为二叶式瓣膜，11例（65%）为三叶式瓣膜。修复方式因瓣膜类型而异，但通常包括瓣叶连合部重新悬吊、部分瓣叶连合部闭合、多余瓣叶的三角形切除或某种组合。
无死亡病例。随访时间为1至11年（平均5.3±2.4年）。目前，根据超声心动图检查，17例中有3例（17.6%）存在轻度主动脉瓣反流，6例（35.2%）存在中度主动脉瓣反流。17例中有8例（47.1%）修复明显失败，在初次手术后0.5至73个月（平均18.9个月）需要再次手术。再次手术包括6例Ross手术和2例机械主动脉瓣置换术。二次手术无死亡病例。
以主动脉瓣关闭不全为主要特征的儿童主动脉瓣修复术往往会逐渐且高比例地失败。在本系列研究中，瓣叶增厚与修复失败的高风险相关。主动脉瓣置换的阈值应保持较低。
