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目的 总结小儿二尖瓣关闭不全外科矫治经验。方法 回顾近 12年我院收治 75例小儿二尖瓣关闭不全患者 ,其中男 3 1例 ,女 4 4例 ,年龄 1 5～ 12岁 ,平均 7 1岁。单纯二尖瓣关闭不全 8例 ,合并其它心血管畸形 67例。二尖瓣关闭不全轻度 7例 ,中度 4 7例 ,重度 2 1例。二尖瓣脱垂 2 4例 ,瓣叶裂 3 8例 ,瓣叶发育不良 2例 ,单纯二尖瓣环扩大 11例。手术在中低温体外循环心内直视下进行 ,行腱索缩短 13例 (含多根腱索缩短 4例 ) ,乳头肌缩短 1例 ,腱索移植 3例 ,瓣叶修复 4 1例 ,瓣环成形 2 5例 ,二尖瓣置换 2例。同时矫正合并心血管畸形。结果 全组无手术死亡。完全矫正二尖瓣关闭不全 5 4例 ( 71 2 % ) ,残留少量反流 17例 ( 2 3 3 % ) ,中度反流 4例 ( 5 5 % )。术后随访 1 5～ 13年(平均 7 8年 ) ,1例术后 4 5年因急性左心衰再次行人工瓣置换术 ,1例合并严重肺动脉高压者术后 5年死于右心衰竭 ,1例人工瓣置换者术后失访。其余患者发育良好 ,心功能均恢复正常。结论 二尖瓣成形术治疗小儿二尖瓣关闭不全可取得良好的效果。
Objective To summarize the experience of pediatric mitral valve regurgitation surgery. Methods Review of nearly 12 years in our hospital admitted to 75 cases of pediatric mitral regurgitation patients, including 31 males and 44 females, aged 15 to 12 years, an average of 71 years. Simple mitral regurgitation in 8 cases, combined with other cardiovascular malformations in 67 cases. Mitral regurgitation mild in 7 cases, moderate in 47 cases, severe 21 cases. 24 cases of mitral valve prolapse, valve leaflet cleft 38 cases, leaflet dysplasia in 2 cases, simple mitral annular enlargement in 11 cases. Underwent cardiopulmonary bypass, the procedure was shortened in 13 cases (4 cases with multiple tendon shortening), 1 case with shortened papillary muscle, 3 cases with tendon graft, 4 cases with flap repair, Ring forming 25 cases, 2 cases of mitral valve replacement. At the same time correction of cardiovascular malformations. Results All patients died without surgery. Complete correction of mitral regurgitation 54 cases (71.2%), a small residual reflux in 17 cases (23%), moderate reflux in 4 cases (55%). The patients were followed up for 15 to 13 years (mean, 78 years). One patient underwent artificial heart replacement with acute left heart failure in 45 years after operation. One patient with severe pulmonary hypertension died of right heart failure 5 years after operation One case of artificial valve replacement was lost after operation. The remaining patients developed well and their cardiac function returned to normal. Conclusions Mitral valvuloplasty can be used to treat children with incomplete mitral regurgitation.