Hillman Neal D, Tani Lloyd Y, Veasy L George, Lambert Linda L, Di Russo Gregory B, Doty Donald B, McGough Edwin C, Hawkins John A
Division of Cardiothoracic Surgery, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah 84113, USA.
Ann Thorac Surg. 2004 Oct;78(4):1403-8. doi: 10.1016/j.athoracsur.2004.04.079.
The incidence of rheumatic heart disease (RHD) has increased recently in the western United States. We reviewed our 18-year surgical experience with RHD in children to examine current surgical techniques and results.
From 1985 until 2003, 596 children (<21 years) with rheumatic fever were seen at Primary Children's Medical Center. Rheumatic carditis was diagnosed in 366 patients (61.4%). Twenty-six with carditis (26/366, 7.1%) required operation for rheumatic valve disease including 8 for mitral regurgitation, 7 for mitral and aortic regurgitation, 4 for aortic regurgitation, 4 for mitral regurgitation and stenosis, 2 for combined mitral stenosis and regurgitation with aortic insufficiency, and 1 for mitral and tricuspid regurgitation.
Mean age at operation was 13.5 +/- 4 years. Three patients required operation during the acute phase of rheumatic fever (< 6 weeks), 2 during the subacute phase (< 6 months), and 21 during the chronic phase after the episode of rheumatic fever (6.7 +/- 3 years). Mitral valve repair was possible in 19 of 22 patients who required mitral operation. Aortic valve repair was possible in 4 patients whereas replacement was necessary in 9, including 2 Ross procedures. No operative deaths were recorded and 2 late deaths occurred at 4.6 and 10 years. Actuarial survival was 94% at 5 years and 78% at 10 years. Six patients required reoperation; actuarial freedom from reoperation was 78% at 5 years, 65% at 10 years, and 49% at 15 years. All survivors are in New York Heart Association class I or II.
Children with RHD in the United States uncommonly require valve operation. Mitral repair with a technique that allows annular growth is possible in most children with good long-term functional results. Long-term surveillance of children with RHD is necessary because of the possible need for late valve operation.
近期美国西部风湿性心脏病（RHD）的发病率有所上升。我们回顾了18年来儿童RHD的外科治疗经验，以研究当前的外科技术及治疗结果。
1985年至2003年期间，原发性儿童医院共诊治了596例年龄小于21岁的风湿热患儿。其中366例（61.4%）被诊断为风湿性心脏炎。26例心脏炎患者（26/366，7.1%）因风湿性瓣膜病需要手术治疗，其中二尖瓣反流8例，二尖瓣和主动脉瓣反流7例，主动脉瓣反流4例，二尖瓣反流合并狭窄4例，二尖瓣狭窄合并反流伴主动脉瓣关闭不全2例，二尖瓣和三尖瓣反流1例。
手术平均年龄为13.5±4岁。3例患者在风湿热急性期（<6周）需要手术，2例在亚急性期（<6个月），21例在风湿热发作后的慢性期（6.7±3年）。22例需要二尖瓣手术的患者中，19例可行二尖瓣修复术。4例患者可行主动脉瓣修复术，9例需要行主动脉瓣置换术，其中包括2例Ross手术。无手术死亡病例，2例晚期死亡分别发生在术后4.6年和10年。5年实际生存率为94%，10年为78%。6例患者需要再次手术；5年免于再次手术的实际概率为78%，10年为65%，15年为49%。所有存活患者的心功能均为纽约心脏协会I级或II级。
美国患有RHD的儿童很少需要瓣膜手术。大多数儿童采用能允许瓣环生长的技术进行二尖瓣修复，可获得良好的长期功能结果。由于可能需要进行晚期瓣膜手术，因此对患有RHD的儿童进行长期监测是必要的。
