Harada Y, Imai Y, Kurosawa H, Ishihara K, Kawada M, Fukuchi S
Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
J Thorac Cardiovasc Surg. 1990 Aug;100(2):175-80.
Since 1979, 50 children, 4 months to 15 years of age, have successfully undergone cardiac valve replacement with the St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). There were 24 boys and 26 girls. The valve replaced was mitral in 28 children, aortic in 15, mitral and aortic in 1, and mitral and tricuspid in 1. A left-sided tricuspid valve was replaced in 3 children. Anticoagulant therapy was maintained in all children; 40 children were treated with warfarin, whereas 10 children who underwent aortic or mitral valve replacement were on a regimen of aspirin combined with dipyridamole. The follow-up period, comprising 224 patient-years, ranged from 1 to 10 years. There were four valve-related complications: one from thromboembolism, two from valve thrombosis, and the other one from prosthetic valve endocarditis. Actuarial rate free from all valve-related complications at 10 years was 84.7%. There were four late deaths: one from valve thrombosis and the others from non-valve-related complications. Actuarial survival rate at 10 years was 90.8%. All surviving children are in functional class I, and no child so far has needed replacement of a prosthesis because of somatic growth. These results indicate that the St. Jude Medical prosthesis is a cardiac valve substitute of choice for valve replacement in children.
自1979年以来，50名年龄在4个月至15岁之间的儿童成功接受了圣犹达医疗公司（位于明尼苏达州圣保罗市）生产的心脏瓣膜置换术。其中男孩24名，女孩26名。置换的瓣膜中，二尖瓣28例，主动脉瓣15例，二尖瓣和主动脉瓣联合置换1例，二尖瓣和三尖瓣联合置换1例。3名儿童置换了左侧三尖瓣。所有儿童均维持抗凝治疗；40名儿童接受华法林治疗，而10名接受主动脉瓣或二尖瓣置换的儿童采用阿司匹林联合双嘧达莫治疗方案。随访期为1至10年，共224个患者年。发生了4例与瓣膜相关的并发症：1例血栓栓塞，2例瓣膜血栓形成，另1例人工瓣膜心内膜炎。10年时无所有瓣膜相关并发症的精算发生率为84.7%。有4例晚期死亡：1例死于瓣膜血栓形成，其他死于非瓣膜相关并发症。10年时的精算生存率为90.8%。所有存活儿童均处于心功能I级，迄今为止没有儿童因身体生长而需要更换人工瓣膜。这些结果表明，圣犹达医疗人工瓣膜是儿童瓣膜置换的首选心脏瓣膜替代品。
