风湿性心脏病患儿的二尖瓣修复术。

Mitral valve repair in children with rheumatic heart disease.

作者信息

Talwar Sachin, Rajesh Manithara Raman, Subramanian Anandaraja, Saxena Anita, Kumar Arkalgud Sampath

机构信息

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.

出版信息

J Thorac Cardiovasc Surg. 2005 Apr;129(4):875-9. doi: 10.1016/j.jtcvs.2004.11.006.

DOI:10.1016/j.jtcvs.2004.11.006

PMID:15821657

Abstract

OBJECTIVE

The purpose of this study was to assess the long-term results of mitral valve repair in children with chronic rheumatic heart disease.

METHODS

From January 1988 through December 2003, 278 children (153 male children) underwent mitral valve repair. Mean age was 11.7 +/- 2.9 years (range, 2-15 years). One hundred seventy-three children (62%) were in the New York Heart Association functional class III or IV. Congestive heart failure was present in 24 (8.6%). Reparative procedures included posterior collar annuloplasty (n = 242), commissurotomy (n = 187), cusp-level chordal shortening (n = 94), cusp thinning (n = 71), cleft suture (n = 65), and cusp excision or plication (n = 10). Associated procedures included atrial septal defect closure (n = 22), aortic valve repair/replacement (n = 13), and tricuspid valve repair (n = 3).

RESULTS

Early mortality was 2.2% (6 patients). Preoperative left ventricular dysfunction was associated with greater mortality. Median follow-up was 56.5 months (mean, 58.9. +/- 32.3 months; range, 5 to 180 months). One hundred seventy-seven survivors (65%) had no or trivial mitral regurgitation. Sixteen patients (6%) required reoperation for valve dysfunction. There were 7 late deaths (2.6%). Actuarial, reoperation-free, and event-free survivals at a median follow-up of 56.5 months were 95.2% +/- 1.5%, 91.6% +/- 2.2%, and 55.9% +/- 3.5%, respectively; at 15 years, they were 95.2% +/- 1.5%, 85.9% +/- 5.9%, and 46.7% +/- 4.7%, respectively.

CONCLUSION

Mitral valve repair in children with chronic rheumatic heart disease is feasible and provides acceptable long-term results.

摘要

目的

本研究旨在评估慢性风湿性心脏病患儿二尖瓣修复术的长期效果。

方法

1988年1月至2003年12月，278例患儿（153例男性）接受了二尖瓣修复术。平均年龄为11.7±2.9岁（范围2至15岁）。173例患儿（62%）属于纽约心脏协会心功能Ⅲ或Ⅳ级。24例（8.6%）存在充血性心力衰竭。修复手术包括后瓣环成形术（n = 242）、交界切开术（n = 187）、瓣尖水平腱索缩短术（n = 94）、瓣尖变薄术（n = 71）、裂缺缝合术（n = 65）以及瓣尖切除或折叠术（n = 10）。相关手术包括房间隔缺损修补术（n = 22）、主动脉瓣修复/置换术（n = 13）以及三尖瓣修复术（n = 3）。

结果

早期死亡率为2.2%（6例患者）。术前左心室功能障碍与较高死亡率相关。中位随访时间为56.5个月（平均58.9±±32.3个月；范围5至180个月）。177例幸存者（65%）无或仅有微量二尖瓣反流。16例患者（6%）因瓣膜功能障碍需要再次手术。有7例晚期死亡（2.6%）。在中位随访56.5个月时，无再手术生存率、无事件生存率分别为95.2%±1.5%、91.6%±2.2%和55.9%±3.5%；在15年时，分别为95.2%±1.5%、85.9%±5.9%和46.7%±4.7%。