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儿童人工腱索二尖瓣修复术的中期结果

Midterm results of mitral valve repair with artificial chordae in children.

作者信息

Minami Kazu, Kado Hideaki, Sai Sadahiro, Tatewaki Hideki, Shiokawa Yuichi, Nakashima Atsuhiro, Fukae Koji, Hirose Hitoshi

机构信息

Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Fukuoka, Japan.

出版信息

J Thorac Cardiovasc Surg. 2005 Feb;129(2):336-42. doi: 10.1016/j.jtcvs.2004.10.016.

Abstract

OBJECTIVE

We have used artificial chordal replacement with expanded polytetrafluoroethylene sutures for mitral valve repair in children and reported favorable early clinical results. In this article we evaluate the midterm results of mitral valve repair with expanded polytetrafluoroethylene sutures in 39 children.

METHODS

From April 1995 through September 2003, mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures was performed in 39 patients. In all patients the preoperative grade of mitral regurgitation was moderate or more because of prolapse of the anterior mitral leaflet. The mean age and body weight at the time of the operation were 4.7 +/- 5.3 years (range, 1 month to 17.8 years) and 14.4 +/- 12.2 kg (range, 3.9-54.4 kg), respectively. The number of expanded polytetrafluoroethylene sutures ranged from 1 to 3 (mean, 1.4). The mean follow-up period and body weight at the latest follow-up were 5.0 +/- 2.3 years (range, 1.1-8.5 years) and 25.7 +/- 16.4 kg (range, 6.9-73 kg), respectively.

RESULTS

There were no operative or late deaths. Only one patient required mitral valve replacement, which occurred 17 days after repair. Two patients underwent redo mitral valve repair 2 and 5 years after initial repair, respectively. The actuarial freedom from reoperation at 5 and 8 years was 94.8% and 89.5%, respectively. At the latest follow-up, trivial or less mitral regurgitation was observed in 33 (84.6%) patients.

CONCLUSIONS

Mitral valve repair with expanded polytetrafluoroethylene sutures in children demonstrated favorable midterm outcome. The procedure is safe and effective, with potential for patients' growth.

摘要

目的

我们已采用膨体聚四氟乙烯缝线进行人工腱索置换术来修复儿童二尖瓣,并报告了良好的早期临床结果。在本文中,我们评估了39例采用膨体聚四氟乙烯缝线进行二尖瓣修复的儿童的中期结果。

方法

从1995年4月至2003年9月,对39例患者采用膨体聚四氟乙烯缝线进行腱索置换二尖瓣修复术。所有患者术前二尖瓣反流程度为中度或更严重,原因是二尖瓣前叶脱垂。手术时的平均年龄和体重分别为4.7±5.3岁(范围1个月至17.8岁)和14.4±12.2千克(范围3.9 - 54.4千克)。膨体聚四氟乙烯缝线的数量为1至3根(平均1.4根)。最新随访时的平均随访时间和体重分别为5.0±2.3年(范围1.1 - 8.5年)和25.7±16.4千克(范围6.9 - 73千克)。

结果

无手术死亡或晚期死亡。仅1例患者在修复后17天需要进行二尖瓣置换。2例患者分别在初次修复后2年和5年接受了再次二尖瓣修复。5年和8年的再次手术无事件生存率分别为94.8%和89.5%。在最新随访时,33例(84.6%)患者观察到轻微或更少的二尖瓣反流。

结论

儿童采用膨体聚四氟乙烯缝线进行二尖瓣修复显示出良好的中期结果。该手术安全有效,对患者生长有潜在可能性。

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