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目的总结12岁以下儿童心脏瓣膜替换术的临床特点及中、远期随访结果 ,初步探讨手术适应证及需要注意的问题。方法本院1999年8月-2009年8月对12岁以下的15例心脏瓣膜病患儿行瓣膜替换术。男9例,女6例;年龄5～12岁,平均8.7岁。手术均在中度低温(24～28℃)体外循环下进行,其中二尖瓣替换12例,主动脉瓣替换2例,三尖瓣替换1例,均采用机械瓣膜。同期合并手术,三尖瓣成型4例,VSD修补2例,主动脉窦瘤破裂修补1例。结果全组无手术死亡病例。术后出现并发症4例(26.7%),其中恶性室性心律失常2例,呼吸衰竭、急性肾衰竭各1例,均经治疗后痊愈。随访7～120个月,平均81个月。随访期死亡3例(20%)。机械瓣功能障碍再手术1例,机械瓣功能障碍观察中1例。余10例瓣膜功能良好,NYHA心功能Ⅰ、Ⅱ级。结论对12岁以下儿童行瓣膜置换术,近期疗效尚可,但术后并发症及中、远病死率较高,应慎重把握手术适应证。
Objective To summarize the clinical features of heart valve replacement in children under 12 years of age and the follow-up results in the medium and long term, and to explore the indications for surgery and the problems needing attention. Methods From August 1999 to August 2009, 15 patients with heart valve disease under the age of 12 underwent valvular replacement. 9 males and 6 females; aged 5 to 12 years, mean 8.7 years old. The operation was performed under moderate hypothermia (24 ~ 28 ℃) under cardiopulmonary bypass. Among them, mitral valve replacement was performed in 12 cases, aortic valve replacement in 2 cases, tricuspid valve replacement in 1 case, and mechanical valves were used. During the same period of combined surgery, tricuspid valvuloplasty in 4 cases, VSD repair in 2 cases, and aneurysm rupture in 1 case. Results The whole group of patients without surgical death. Complications occurred in 4 cases (26.7%) after operation, including 2 cases of malignant ventricular arrhythmia, 1 case of respiratory failure and acute renal failure, all of which recovered after treatment. Follow-up 7 to 120 months, an average of 81 months. 3 cases died of follow-up (20%). Mechanical valve dysfunction in 1 case re-operation, mechanical valve dysfunction in 1 case. More than 10 cases of valve function well, NYHA cardiac function Ⅰ, Ⅱ grade. Conclusion Valvuloplasty for children under 12 years of age has a short-term curative effect. However, the postoperative complications and the high mortality rate in the medium and long term should be carefully grasped.