Giordano Raffaele, Cantinotti Massimiliano, Pak Vitali, Arcieri Luigi, Poli Vincenzo, Assanta Nadia, Moschetti Riccardo, Murzi Bruno
Pediatric Cardiac Surgery, The Heart Hospital, Tuscany Foundation "Gabriele Monasterio", Massa, Italy.
J Card Surg. 2015 Feb;30(2):185-9. doi: 10.1111/jocs.12501. Epub 2014 Dec 29.
Mitral valve replacement (MVR) is a surgical option when mitral valvuloplasty is not feasible/successful. This study reviews our experience with MVR in very young children.
From July 2004 to January 2014, seven children (mean age 13.3 ± 11.2 months; range 4 months to 35 months; mean body weight 6.0 ± 2.2 kg) underwent MVR with a mechanical prosthesis in the supra-annular position. To provide better exposure in the left atrium, we performed in all but one case a biatrial transeptal incision according to Guiraudon. Six patients had congenital defects of the mitral valve and one had rheumatic. Six patients had undergone previous cardiosurgical procedures.
All patients were implanted with a CarboMedics (CarboMedics, Austin, TX, USA) mechanical prosthesis. Mean prosthesis size was 19.0 ± 3.1 mm (range 16 to 25). There were no cases of operative or late mortality. At follow-up (mean 67.1 ± 34.8 months; range 25 to 108 months) two patients (28.6%) required reoperation both for thrombotic pannus formation over the disc at two and three months from first operation, respectively; only in one case was replacement necessary.
Supra-annular MVR may be considered a feasible secondary surgical option in children with a small annulus when mitral valvuloplasty is unsuccessful or unsuitable. Early and mid-term outcomes are acceptable but complications are not uncommon, especially related to thrombotic events.
当二尖瓣成形术不可行或不成功时，二尖瓣置换术（MVR）是一种手术选择。本研究回顾了我们在非常年幼患儿中进行MVR的经验。
2004年7月至2014年1月，7名儿童（平均年龄13.3±11.2个月；范围4个月至35个月；平均体重6.0±2.2 kg）在瓣环上位置植入机械瓣膜进行MVR。为了更好地暴露左心房，除1例患者外，其余所有患者均按照吉劳东方法进行双心房跨房间隔切口。6例患者有二尖瓣先天性缺陷，1例有风湿性病变。6例患者曾接受过心脏外科手术。
所有患者均植入了美国德克萨斯州奥斯汀市CarboMedics公司的机械瓣膜。平均瓣膜尺寸为19.0±3.1 mm（范围16至25）。无手术或晚期死亡病例。随访时（平均67.1±34.8个月；范围25至108个月），2例患者（28.6%）分别在首次手术后2个月和3个月因瓣膜盘上血栓性 pannus形成需要再次手术；仅1例需要更换瓣膜。
当二尖瓣成形术不成功或不适用时，瓣环上MVR可被认为是瓣环小的儿童可行的二次手术选择。早期和中期结果可以接受，但并发症并不少见，尤其是与血栓形成事件相关的并发症。
