Shi Yi, Xu Haitao, Yan Jun, Wang Qiang, Li Shoujun, Yi Tong, Zhang Yajuan, Liu Wenchao
Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing, 100037, People's Republic of China.
Pediatr Cardiol. 2017 Dec;38(8):1592-1597. doi: 10.1007/s00246-017-1701-y. Epub 2017 Jul 31.
The objective of this study was to assess the mid-term results of mitral valve (MV) repair in infancy and childhood with isolated mitral regurgitation (MR). From January 2005 to January 2016, 40 consecutive patients with isolated MR underwent MV repair in Fuwai Hospital, Beijing, China. Patients' clinical data were analyzed retrospectively. Mean age at operation was 13 ± 5 (6-24) months and 22 patients (55%) were younger than 1 year. Mean weight at operation was 8.5 ± 1.9 (4.2-13) kg and 34 patients (85%) were lighter than 10 kg. All patients presented moderate or greater MR. After MV repair, all patients had mild MR or none, while two patients underwent re-repair immediately when TEE showed moderate MR. Mean left atrial diameter decreased from 28.0 ± 6.5 to 20.7 ± 4.8 mm and mean left ventricular end-diastolic diameter decreased from 38.6 ± 7.0 to 30.2 ± 4.9 mm (p < 0.001 for both). There was no early death. Clinical follow-up was conducted in 37 patients over an average period of 49 ± 31 (20-134) months. Follow-up echocardiography showed that one patient had severe MR who underwent redo repair 14 months after operation, one patient had moderate to severe MR, and three patients had moderate MR. Overall freedom from moderate or greater MR was 96.3 ± 3.6%, 91.9 ± 5.5%, and 83.6 ± 9.4% at 2, 5, and 10 years, respectively. The early and mid-term results of MV repair in pediatric patients with isolated MR were satisfactory. In majority of patients, less complex surgical repair techniques were utilized, namely annuloplasty or commissuroplasty. The combination of various repair methods in complex patients could achieve excellent outcome.
本研究的目的是评估婴儿期和儿童期孤立性二尖瓣反流（MR）患者二尖瓣（MV）修复的中期结果。2005年1月至2016年1月，中国北京阜外医院连续40例孤立性MR患者接受了MV修复。对患者的临床资料进行回顾性分析。手术时的平均年龄为13±5（6 - 24）个月，22例患者（55%）年龄小于1岁。手术时的平均体重为8.5±1.9（4.2 - 13）kg，34例患者（85%）体重低于10 kg。所有患者均表现为中度或更严重的MR。MV修复后，所有患者均有轻度MR或无MR，而2例患者在经食管超声心动图（TEE）显示中度MR时立即进行了再次修复。平均左心房直径从28.0±6.5降至20.7±4.8 mm，平均左心室舒张末期直径从38.6±7.0降至30.2±4.9 mm（两者p均<0.001）。无早期死亡。对37例患者进行了平均49±31（20 - 134）个月的临床随访。随访超声心动图显示，1例患者有严重MR，在术后14个月接受了再次修复，1例患者有中度至重度MR，3例患者有中度MR。在2年、5年和10年时，总体免于中度或更严重MR的比例分别为96.3±3.6%、91.9±5.5%和83.6±9.4%。孤立性MR儿科患者MV修复的早期和中期结果令人满意。在大多数患者中，采用了不太复杂的手术修复技术，即瓣环成形术或交界成形术。复杂患者中多种修复方法的联合应用可取得优异的效果。
