Solymar L, Rao P S, Mardini M K, Fawzy M E, Guinn G
Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Am Heart J. 1991 Feb;121(2 Pt 1):557-68. doi: 10.1016/0002-8703(91)90726-x.
The purpose of this paper is to present the short- and long-term results of prosthetic valve replacement in children. During a 7-year period that ended in April 1985, 186 children, ages 1 to 20 years, underwent valve replacement; there were 55 (30%) aortic valve replacements, 95 (51%) mitral valve replacements, and 36 (19%) multiple valve replacements. Ninety-four percent of the lesions were rheumatic in origin, 4% were congenital, and 2% were infectious. Of 223 valves replaced, 175 (78%) were mechanical valves and 48 (22%) were heterografts; the latter were in the mitral position in all but three patients. Surgical mortality rates were 3.6%, 4.2%, and 19.4% respectively for aortic valve, mitral valve, and multiple valve replacements. Five-year actuarial survival was 91% for aortic valve replacement, 82% for mitral valve replacement and 60% for multiple valve replacement. Major events included reoperation in 34 (with three deaths), progressive myocardial failure that led to death in 10, sudden unexpected death in two, thromboembolic complications in 19 (death in five), subacute bacterial endocarditis in five (two deaths), and bleeding that required transfusion in two patients. Five-year complication-free actuarial survival rates were 83% for aortic valve replacement, 63% for mitral valve replacement, and 57% for multiple valve replacement. The respective five-year complication-free survival rates were 83%, 48%, and 43%. Significant morbidity and mortality rates are associated with valve replacement. Therefore every effort should be made to preserve the native valve by plastic reparative procedures. When prosthetic replacement of mitral valve is contemplated, our data would suggest that heterografts should not be inserted in children 15 years of age or younger, although heterografts may be used in children over 15 years of age with the expectation of valve survival comparable to that of mechanical valves. When complications that are associated with anticoagulant therapy were reviewed, platelet inhibiting drugs seem quite satisfactory in patients with aortic valve replacement; patients with mitral valve replacement seem to require warfarin therapy, and warfarin must be used in patients with multiple valve replacement to reduce the risk of thromboembolic complications.
本文旨在介绍儿童人工瓣膜置换的短期和长期结果。在截至1985年4月的7年期间，186名年龄在1至20岁的儿童接受了瓣膜置换；其中55例（30%）为主动脉瓣置换，95例（51%）为二尖瓣置换，36例（19%）为多瓣膜置换。94%的病变起源于风湿性，4%为先天性，2%为感染性。在223个置换的瓣膜中，175个（78%）为机械瓣膜，48个（22%）为异种生物瓣膜；除3例患者外，后者均位于二尖瓣位置。主动脉瓣置换、二尖瓣置换和多瓣膜置换的手术死亡率分别为3.6%、4.2%和19.4%。主动脉瓣置换的5年精算生存率为91%，二尖瓣置换为82%，多瓣膜置换为60%。主要事件包括34例再次手术（3例死亡）、10例因进行性心肌衰竭导致死亡、2例意外猝死、19例血栓栓塞并发症（5例死亡）、5例亚急性细菌性心内膜炎（2例死亡）以及2例患者因出血需要输血。主动脉瓣置换、二尖瓣置换和多瓣膜置换的5年无并发症精算生存率分别为83%、63%和57%。各自的5年无并发症生存率分别为83%、48%和43%。瓣膜置换与显著的发病率和死亡率相关。因此，应尽一切努力通过整形修复手术保留自身瓣膜。当考虑二尖瓣的人工置换时，我们的数据表明，对于15岁及以下的儿童不应植入异种生物瓣膜，尽管对于15岁以上的儿童可以使用异种生物瓣膜，预期瓣膜生存率与机械瓣膜相当。当回顾与抗凝治疗相关的并发症时，血小板抑制药物对于主动脉瓣置换患者似乎相当令人满意；二尖瓣置换患者似乎需要华法林治疗，多瓣膜置换患者必须使用华法林以降低血栓栓塞并发症的风险。
