Perth Children's Hospital, Perth Western Australia, Nedlands, WA, Australia.
The School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Telethon Kids Institute, Perth Western Australia, Nedlands, WA, Australia.
Heart Lung Circ. 2023 Nov;32(11):1398-1406. doi: 10.1016/j.hlc.2023.08.012. Epub 2023 Oct 16.
Surgical intervention is an important treatment modality for advanced rheumatic heart disease (RHD). This study aimed to describe patient characteristics and outcomes from cardiac surgery for RHD in patients referred to the only tertiary paediatric hospital in Western Australia.
An analysis of patient characteristics and cardiac surgery outcomes in patients with RHD was undertaken, using data from clinical cardiac databases, medical notes, and correspondence from rural outreach clinics.
29 patients (59% female, 97% Aboriginal, Māori or Pacific Islander) underwent 41 valve interventions over 34 cardiac surgeries for RHD between 2000-2018. Median age at first surgery was 12.2 (range 4-16) years. Severe mitral regurgitation (MR) was the most common indication for primary surgery (62%), followed by mixed mitral regurgitation/aortic regurgitation (21%) and severe aortic regurgitation (17%). Mitral valve repair was the most common valve intervention (56%). Two patients had mitral valve replacement (MVR) at first operation, two patients had MVR at second operation and two had MVR at third operation. There was no early mortality. One patient required early (<30 days) reoperation for aortic valve repair failure. Two patients had late reoperations at 3.3 and 6.1 months after the first procedure for MR. Four (14%) patients experienced documented ARF recurrences. Late mortality occurred in 3 (10%) patients, all due to cardiac causes. On last follow-up echocardiogram 5 patients (17%) had moderate MR and none had severe MR.
This is the first study to describe characteristics and outcomes in WA paediatric patients having surgery for RHD. Outcomes are comparable to similar studies, with favourable long-term survival.
手术干预是治疗晚期风湿性心脏病（RHD）的重要治疗方法。本研究旨在描述在西澳大利亚唯一的三级儿科医院就诊的 RHD 患者接受心脏手术的患者特征和结局。
使用临床心脏数据库、病历和农村外展诊所的信件中的数据，对 RHD 患者的患者特征和心脏手术结果进行了分析。
2000-2018 年间，29 名患者（59%为女性，97%为原住民、毛利人或太平洋岛民）接受了 41 次瓣膜介入治疗，共进行了 34 次心脏手术治疗 RHD。首次手术的中位年龄为 12.2 岁（范围为 4-16 岁）。原发性手术的最常见指征是严重二尖瓣反流（MR）（62%），其次是混合性二尖瓣反流/主动脉瓣反流（21%）和严重主动脉瓣反流（17%）。最常见的瓣膜介入是二尖瓣修复术（56%）。有 2 名患者在第一次手术时接受了二尖瓣置换术（MVR），2 名患者在第二次手术时接受了 MVR，2 名患者在第三次手术时接受了 MVR。无早期死亡。1 名患者因主动脉瓣修复失败而早期（<30 天）需要再次手术。2 名患者在第一次手术后 3.3 和 6.1 个月进行了晚期再手术，均因 MR 进行。4 名（14%）患者出现记录的 ARF 复发。3 名（10%）患者发生晚期死亡，均因心脏原因导致。最后一次随访时，5 名患者（17%）出现中度 MR，无重度 MR。
这是第一项描述西澳大利亚儿科患者接受 RHD 手术的特征和结局的研究。结果与类似研究相似，长期生存率良好。
