Boon Rody, Hazekamp Mark, Hoohenkerk Gerard, Rijlaarsdam Marry, Schoof Paul, Koolbergen Dave, Heredia Lourdes, Dion Robert
Leiden University Medical Center, Leiden, Netherlands.
Eur J Cardiothorac Surg. 2007 Jul;32(1):143-8. doi: 10.1016/j.ejcts.2007.03.035. Epub 2007 May 2.
To evaluate pediatric atrioventricular valve repair with artificial chordae.
Between February 2001 and January 2006, artificial chords were used in 21 children with severe mitral or tricuspid valve regurgitation. Patients with AVSD were excluded. Median age was 84 (1-194) months. Five patients had isolated tricuspid valve anomalies, 16 had mitral valve anomalies (associated tricuspid annular dilatation in 4). Tricuspid neochordae were placed to anterior (three patients) and septal (two patients) leaflets. Mitral neochordae were placed to anterior (15 patients) and posterior (1 patient) leaflets. Additional ring annuloplasties were performed in 12 (mitral 11, tricuspid 1), as well as 2 de Vega tricuspid annuloplasties. Patch insertion was used in acute endocarditis (tricuspid one). All echocardiographic studies were reviewed and analyzed by a single cardiologist.
No mortality occurred. Follow-up was complete (mean 28+/-18 months). Two patients were reoperated, one for mitral ring dehiscence and one for recurring mitral valve insufficiency. Both valves were replaced by mechanical valve prosthesis. At last follow-up tricuspid insufficiency was mild (three) or moderate (two). Moderate insufficiency occurred due to remaining restriction of the septal leaflet after repair in endocarditis (one) and remaining prolapse of the anterior leaflet (one). Mitral insufficiency was absent (five), mild (seven), or moderate (two). Moderate insufficiency was caused by recurrent anterior leaflet shortening after valve repair in rheumatic valve disease (two). Valve restriction caused by artificial chordae was not found.
Mitral and tricuspid valve repair with artificial chordae in children demonstrated acceptable results. Despite patient growth, valvular restriction by the artificial chordae was not observed ad mid-term follow-up.
评估人工腱索在小儿房室瓣修复中的应用。
2001年2月至2006年1月期间，21例患有严重二尖瓣或三尖瓣反流的儿童使用了人工腱索。房室间隔缺损患者被排除在外。中位年龄为84（1 - 194）个月。5例患者为孤立性三尖瓣异常，16例为二尖瓣异常（4例伴有三尖瓣环扩张）。三尖瓣新腱索置于前叶（3例患者）和隔叶（2例患者）。二尖瓣新腱索置于前叶（15例患者）和后叶（1例患者）。12例患者进行了额外的瓣环成形术（二尖瓣11例，三尖瓣1例），以及2例德维加三尖瓣瓣环成形术。1例急性心内膜炎（三尖瓣）患者采用补片植入。所有超声心动图研究均由一名心脏病专家进行回顾和分析。
无死亡病例。随访完整（平均28±18个月）。2例患者再次手术，1例因二尖瓣环裂开，1例因复发性二尖瓣关闭不全。两枚瓣膜均被机械瓣膜假体置换。在最后一次随访时，三尖瓣关闭不全为轻度（3例）或中度（2例）。中度关闭不全是由于心内膜炎修复后隔叶仍有受限（1例）以及前叶仍有脱垂（1例）。二尖瓣关闭不全不存在（5例）、轻度（7例）或中度（2例）。中度关闭不全是由风湿性瓣膜病瓣膜修复后前叶反复缩短所致（2例）。未发现人工腱索导致瓣膜受限。
小儿二尖瓣和三尖瓣人工腱索修复显示出可接受的结果。尽管患者生长，但在中期随访中未观察到人工腱索导致瓣膜受限。
