Borkon A M, Soule L, Reitz B A, Gott V L, Gardner T J
Circulation. 1986 Sep;74(3 Pt 2):I110-5.
Since 1979, 34 infants and children, 3 weeks to 17 years of age, have undergone cardiac valve replacement with a St. Jude Medical (SJM) prosthesis at our institution. Seventeen children underwent mitral valve replacement (MVR), 16 aortic valve replacement (AVR), and one pulmonary valve replacement. Three hospital deaths were associated with MVR and complex congenital heart disease. All surviving patients were functional in class I. A cumulative 89.1 patient-years of follow-up were analyzed to evaluate valve-related mortality and morbidity. Late complications included thromboembolus (one patient), anticoagulant-related hemorrhage (one patient), and perivalvular leak (one patient). One of six late deaths resulted from mitral valve thrombosis. Actuarial 5 year survival for patients who underwent AVR was 100%, but it was 53% for MVR (p = .03). Freedom from significant morbidity and mortality for up to 5 years after operation was 92 +/- 7% for those who underwent AVR and 45 +/- 16% for those who underwent MVR. Patient-related factors appear to account for an increased rate of complications after MVR. Because of difficulties with achieving anticoagulation with warfarin, aspirin therapy should be used for patients less than 5 years of age, while older patients can be managed with warfarin. The SJM valve is a satisfactory cardiac valve substitute for the pediatric age group.
自1979年以来，我院对34名年龄在3周龄至17岁的婴幼儿及儿童进行了圣犹达医疗公司（SJM）人工心脏瓣膜置换术。其中17名儿童接受了二尖瓣置换术（MVR），16名接受了主动脉瓣置换术（AVR），1名接受了肺动脉瓣置换术。3例住院死亡与MVR及复杂先天性心脏病有关。所有存活患者心功能均为I级。对累计89.1患者年的随访资料进行分析，以评估瓣膜相关的死亡率和发病率。晚期并发症包括血栓栓塞（1例患者）、抗凝相关出血（1例患者）和瓣周漏（1例患者）。6例晚期死亡中有1例死于二尖瓣血栓形成。接受AVR患者的5年预期生存率为100%，而接受MVR患者的为53%（p = 0.03）。接受AVR患者术后长达5年无严重并发症和死亡的比例为92±7%，接受MVR患者的为45±16%。患者相关因素似乎是MVR后并发症发生率增加的原因。由于华法林抗凝存在困难，5岁以下患者应使用阿司匹林治疗，而年龄较大的患者可使用华法林治疗。SJM瓣膜是小儿年龄组令人满意的心脏瓣膜替代品。
