Breinholt John P, Fraser Charles D, Dreyer William J, Chang Anthony C, O'Brian Smith E, Heinle Jeffrey S, Dean McKenzie E, Clunie Sarah K, Towbin Jeffrey A, Denfield Susan W
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
Pediatr Cardiol. 2008 Jan;29(1):13-8. doi: 10.1007/s00246-007-9050-x. Epub 2007 Sep 11.
Severe mitral regurgitation predicts poor outcomes in adults with left ventricular dysfunction. Frequently, adult patients now undergo initial mitral valve surgery instead of heart transplant. Pediatric data are limited. This study evaluates the efficacy of mitral valve surgery for severe mitral regurgitation in children with dilated cardiomyopathy. This is a single-institution experience in seven children (range, 0.5-10.9 years) with severe mitral regurgitation and dilated cardiomyopathy who underwent mitral valve surgery between January 1988 and February 2005, with follow-up to January 2006. Children with dilated cardiomyopathy had a depressed fractional shortening preoperatively (24.4% +/- 6.1%) that remained depressed (22.9% +/- 7.6%) 1.3 +/- 1.2 years after surgery (p = 0.50). Left ventricular end-diastolic (6.5 +/- 1.5 to 4.8 +/- 1.8 z-scores, p < 0.01) and end-systolic (6.8 +/- 1.5 to 5.5 +/- 2.1 z-scores, p < 0.05) dimensions improved. Hospitalization frequency had a median decrease of 6.0 hospitalizations per year (p < 0.02). Three patients were transplanted 0.2, 2.4, and 3.5 years after surgery. There was no perioperative mortality. Mitral valve surgery in children with dilated cardiomyopathy was performed safely and improved symptoms, stabilizing ventricular dysfunction in most patients. Mitral valve surgery should be considered prior to heart transplant in children with dilated cardiomyopathy and severe mitral regurgitation.
严重二尖瓣反流预示着左心室功能不全的成人患者预后不良。目前，成年患者常接受初次二尖瓣手术而非心脏移植。儿科数据有限。本研究评估二尖瓣手术治疗扩张型心肌病患儿严重二尖瓣反流的疗效。这是一项单中心研究，纳入了1988年1月至2005年2月期间接受二尖瓣手术的7例严重二尖瓣反流和扩张型心肌病患儿（年龄范围为0.5至10.9岁），随访至2006年1月。扩张型心肌病患儿术前缩短分数降低（24.4%±6.1%），术后1.3±1.2年仍降低（22.9%±7.6%）（p = 0.50）。左心室舒张末期内径（z评分从6.5±1.5降至4.8±1.8，p < 0.01）和收缩末期内径（z评分从6.8±1.5降至5.5±2.1，p < 0.05）有所改善。住院频率中位数每年减少6.0次住院（p < 0.02）。3例患者在术后0.2年、2.4年和3.5年接受了心脏移植。无围手术期死亡。扩张型心肌病患儿二尖瓣手术实施安全，症状改善，多数患者心室功能障碍得以稳定。对于扩张型心肌病合并严重二尖瓣反流的患儿，应在心脏移植前考虑二尖瓣手术。
