风湿性心脏病青少年的人工瓣膜置换术。

Prosthetic valve replacement in adolescents with rheumatic heart disease.

作者信息

Akhtar Raja P, Abid Abdul R, Zafar Hasnain, Sheikh Saqib S, Cheema Masud A, Khan Jawad S

机构信息

Department of Cardiac Surgery, Punjab Institute of Cardiology, Ghaus-ul-Azam Road, Lahore, Pakistan.

出版信息

Asian Cardiovasc Thorac Ann. 2007 Dec;15(6):476-81. doi: 10.1177/021849230701500606.

DOI:10.1177/021849230701500606

PMID:18042771

Abstract

To assess long-term survival and anticoagulant-related complications after mechanical valve replacement in adolescents with rheumatic heart disease, 88 patients aged <or= 18 years were prospectively followed up for 10 years (404.2 patient-years). There were 58 (65.9%) boys and 30 (34.1%) girls, with a mean age of 15.4 +/- 2.1 years. Mitral regurgitation was detected in 39 (44.3%) patients, and both mitral and aortic regurgitation in 15 (17%). Ball valves were inserted in 52 (59.1%) patients, bileaflet valves in 31 (35.2%), and single-disc valves in 5 (5.7%). There were 4 (4.5%) hospital deaths and 11 late deaths. Patient survival at 30 days, 3 months, 1, 5, and 10 years was 95.5%, 93.2%, 87.5%, 82.9%, and 82.9%, respectively. Mechanical valve thrombosis occurred in 4 patients; it was fatal in 3 of them. Three patients died from stroke. Severe hemorrhage required hospital admission in 4 (4.5%) patients. Mechanical valve replacement in adolescents, with careful follow-up and anticoagulation, has acceptable long-term results.

摘要

为评估风湿性心脏病青少年患者机械瓣膜置换术后的长期生存率及抗凝相关并发症，对88例年龄≤18岁的患者进行了为期10年的前瞻性随访（404.2患者年）。其中男孩58例（65.9%），女孩30例（34.1%），平均年龄15.4±2.1岁。39例（44.3%）患者检测到二尖瓣反流，15例（17%）患者同时存在二尖瓣和主动脉瓣反流。52例（59.1%）患者植入球瓣，31例（35.2%）患者植入双叶瓣，5例（5.7%）患者植入单盘瓣。住院死亡4例（4.5%），晚期死亡11例。术后30天、3个月、1年、5年和10年的患者生存率分别为95.5%、93.2%、87.5%、82.9%和82.9%。4例患者发生机械瓣膜血栓形成，其中3例死亡。3例患者死于中风。4例（4.5%）患者因严重出血需住院治疗。青少年患者进行机械瓣膜置换，经过仔细随访和抗凝治疗，可获得可接受的长期效果。