Delmo Walter Eva Maria, Javier Mariano, Hetzer Roland
Trauma Surgery Centre Berlin, Berlin Germany.
Trauma Surgery Centre Berlin, Berlin Germany.
Semin Thorac Cardiovasc Surg. 2016;28(2):448-459. doi: 10.1053/j.semtcvs.2016.04.011. Epub 2016 Apr 27.
Parachute and hammock valves in children remain one of the most challenging congenital malformations to correct. We report our institutional experience with valve-preserving repair techniques and the early and late surgical outcomes in parachute and hammock valves in infants and children. From January 1990-June 2014, 20 infants and children with parachute (n = 12, median age = 2.5 years, range: 2 months-13 years) and hammock (n = 8, median age = 7 months, range: 1 month-14.9 years) valves underwent mitral valve (MV) repair. Children with parachute valves have predominant stenosis, whereas those with hammock valves often have predominant insufficiency. Intraoperative findings included fused and shortened chordae with single papillary muscles in children with parachute valves. MV repair was performed using annuloplasty, commissurotomy, leaflet incision toward the body of the papillary muscles, and split toward its base. Children with hammock valves have dysplastic and shortened chordae, absence of papillary muscles with fused and thickened commissures. MV repair consisted of carving off a suitably thick part of the left ventricular wall carrying the rudimentary chordae. The degree and extent of incision and commissurotomy is determined by the minimal age-related acceptable MV diameter to avoid mitral stenosis. During a median duration of follow-up of 9.6 years (range: 6.4-21.4 years), cumulative survival rate and freedom from reoperation in parachute valves were 43.7 ± 1.6% and 53.0 ± 1.8%, respectively. In hammock valves, during a median duration of follow-up of 6.7 years (range: 2.7-19.4 years), cumulative survival rate and freedom from reoperation was 72.9 ± 1.6% and 30.0 ± 1.7%, respectively. Age less than 1 year proved to be a high-risk factor for reoperation and mortality (P < 0.005). In conclusion, children with parachute and hammock valves, repeat MV repair may be necessary during the course of follow-up. Infants have a greater risk for reoperation and mortality.
儿童降落伞瓣和吊床瓣仍然是最难矫正的先天性畸形之一。我们报告了我们机构在婴儿和儿童降落伞瓣和吊床瓣中采用保留瓣膜修复技术的经验以及早期和晚期手术结果。1990年1月至2014年6月，20例患有降落伞瓣（n = 12，中位年龄 = 2.5岁，范围：2个月至13岁）和吊床瓣（n = 8，中位年龄 = 7个月，范围：1个月至14.9岁）的婴儿和儿童接受了二尖瓣修复术。患有降落伞瓣的儿童主要表现为狭窄，而患有吊床瓣的儿童则常以反流为主。术中发现降落伞瓣儿童存在融合和缩短的腱索以及单一乳头肌。二尖瓣修复采用瓣环成形术、交界切开术、向乳头肌主体方向的瓣叶切开术以及向其基部的劈开术。患有吊床瓣的儿童存在发育异常和缩短的腱索，无乳头肌且交界融合增厚。二尖瓣修复包括切除携带发育不全腱索的左心室壁的适当厚的部分。切口和交界切开的程度和范围由与年龄相关的最小可接受二尖瓣直径决定，以避免二尖瓣狭窄。在中位随访期9.6年（范围：6.4至21.4年）内，降落伞瓣的累积生存率和免于再次手术率分别为43.7 ± 1.6%和53.0 ± 1.8%。在吊床瓣中，中位随访期6.7年（范围：2.7至19.4年）内，累积生存率和免于再次手术率分别为72.9 ± 1.6%和30.0 ± 1.7%。年龄小于1岁被证明是再次手术和死亡的高危因素（P < 0.005）。总之，患有降落伞瓣和吊床瓣的儿童在随访过程中可能需要再次进行二尖瓣修复。婴儿再次手术和死亡的风险更高。
