Ben-Ismail M, Kafsi N, Taktak M
Arch Mal Coeur Vaiss. 1979 Jul;72(7):739-46.
Over a 10 year period, 95 children aged 15 years and less underwent replacement of one or several of their heart valves, usually by a Starr-Edwards ball prosthesis. The predominant pathology was rheumatic heart disease and the most commonly affected valve was the mitral. Severe symptomatology, heart failure, cardiomegaly and high wedged-capillary and pulmonary arterial pressures were practically constant findings. Operative mortality was low (3.2%) and the long-term mortality was 10 patients. With an average follow-up of 40 months, results were excellent in the great majority of patients, with complete regression of symptoms, cardiomegaly and high capillary and pulmonary arterial pressures. Anticoagulant therapy was not systematic and only half the series were so treated. Thromboembolic complications were rare, 5.5% patients, but only affected those without anticoagulant therapy. The problems of evolving rheumatic disease and, above all, of tricuspid incompetence, the persistence of which after surgery on the mitral valve seems to be a sign of advanced myocardial damage, are discussed.
在10年期间，95名15岁及以下儿童接受了一个或多个心脏瓣膜置换手术，通常采用斯塔尔-爱德华兹球瓣假体。主要病理为风湿性心脏病，最常受累的瓣膜是二尖瓣。严重症状、心力衰竭、心脏扩大以及高楔压毛细血管和肺动脉压几乎是持续存在的表现。手术死亡率较低（3.2%），长期死亡10例。平均随访40个月，绝大多数患者效果良好，症状、心脏扩大以及高毛细血管和肺动脉压完全消退。抗凝治疗并非常规进行，只有一半患者接受了该治疗。血栓栓塞并发症罕见，发生率为5.5%，但仅发生在未接受抗凝治疗的患者中。文中讨论了风湿性疾病的进展问题，尤其是三尖瓣关闭不全问题，二尖瓣手术后三尖瓣关闭不全的持续存在似乎是心肌严重受损的标志。
