Arnold Raoul, Ley-Zaporozhan Julia, Ley Sebastian, Loukanov Tsvetomir, Sebening Christian, Kleber Johann-Baptist, Goebel Björn, Hagl Siegfried, Karck Matthias, Gorenflo Matthias
Department of Pediatric Cardiology, University Medical Centre, Freiburg, Germany.
Ann Thorac Surg. 2008 Feb;85(2):604-10. doi: 10.1016/j.athoracsur.2007.10.035.
We asked whether aortic valve replacement using a mechanical prosthesis would allow normalization of left ventricular function and structure in children and young adults.
We performed a clinical follow-up examination in 30 patients with aortic valve replacement at 25 years of age or younger, including conventional and tissue Doppler echocardiography and magnetic resonance imaging.
Aortic valve replacement was performed at the median age of 14.3 years (range, 7.6 to 24.3 years) using a mechanical prosthesis (St. Jude Medical; median diameter, 23 mm; range, 17 to 27 mm). Indications were severe aortic stenosis in 6 of 30 patients, aortic regurgitation in 20 of 30 patients, or a combination of aortic stenosis and regurgitation (4 of 30 patients). Aortic valve replacement was a reoperation in 12 of 30 patients who primarily underwent aortic valvotomy at a median of 7.1 years (range, 1.0 to 11.3 years). In-hospital mortality was 0%. Follow-up was a median of 6 years (range, 1.2 to 14.5 years). Twenty-nine of 30 patients were in New York Heart Association functional class I without thromboembolic complications, cerebrovascular accidents, or major bleeding on oral anticoagulation. Left ventricular dilatation before aortic valve replacement was present in 20 of 30 patients but normalized in all but 4 patients on follow-up. Most patients showed a normal end-diastolic volume on magnetic resonance imaging, and 23 of 26 patients showed a normal left ventricular ejection fraction (median, 0.53; range, 0.33 to 0.75). Peak systolic strain of the left ventricular myocardium was a median of -13.3% (range, -0.5% to -31%), and was normal in 28 of 30 patients.
Aortic valve replacement in children and young adults offers a good treatment option and may lead to normalization of left ventricular size and function in most patients.
我们探讨了使用机械瓣膜进行主动脉瓣置换术是否能使儿童和年轻成人的左心室功能和结构恢复正常。
我们对30例25岁及以下接受主动脉瓣置换术的患者进行了临床随访检查，包括常规和组织多普勒超声心动图以及磁共振成像。
主动脉瓣置换术在中位年龄14.3岁（范围7.6至24.3岁）时进行，使用机械瓣膜（圣犹达医疗公司；中位直径23毫米；范围17至27毫米）。30例患者中，6例为重度主动脉瓣狭窄，20例为主动脉瓣关闭不全，4例为主动脉瓣狭窄合并关闭不全。30例患者中有12例是再次手术，他们最初在中位年龄7.1岁（范围1.0至11.3岁）时接受了主动脉瓣切开术。住院死亡率为0%。随访时间中位值为6年（范围1.2至14.5年）。30例患者中有29例纽约心脏协会心功能分级为I级，且无血栓栓塞并发症、脑血管意外或口服抗凝药引起的大出血。30例患者中有20例在主动脉瓣置换术前存在左心室扩张，但随访时除4例患者外其余患者均恢复正常。大多数患者磁共振成像显示舒张末期容积正常，26例患者中有23例左心室射血分数正常（中位值0.53；范围0.33至0.75）。左心室心肌的收缩期峰值应变中位值为-13.3%（范围-0.5%至-31%），30例患者中有28例正常。
儿童和年轻成人的主动脉瓣置换术是一种良好的治疗选择，多数患者的左心室大小和功能可能恢复正常。
