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目的总结三尖瓣前瓣扩大技术在15岁及以下儿童再次三尖瓣手术中的应用经验,初步探讨三尖瓣前瓣扩大技术的应用指征、手术技巧等相关问题。方法回顾性分析2006年1月至2015年10月上海交通大学医学院附属新华医院再次三尖瓣成形术中行三尖瓣前瓣扩大技术的23例患儿的临床资料,其中男15例、女8例,平均年龄8.7(5~15)岁。术中使用人工心包补片扩大三尖瓣前瓣叶。术后以华法林抗凝治疗,维持国际标准化比值(INR)在2.0~3.0。结果全组患儿体外循环时间87~132(98.5±35.7)min,主动脉阻断时间56~97(68.40±23.78)min。院内死亡1例,术后出现并发症3例,其中呼吸衰竭、肾功能不全、右心功能不全各1例,均经治疗后痊愈。随访5个月~10年,平均3.5年,随访期间死亡1例,有6例患儿出现轻-中度三尖瓣关闭不全,其余患儿三尖瓣功能良好,无再次手术,无抗凝相关并发症。结论对于需要再次行三尖瓣手术的患儿应用三尖瓣前瓣扩大技术,围术期及术后密切治疗,能取得良好的近中期疗效。
Objective To summarize the application experience of tricuspid valve augmentation in children under 15 years of age undergoing tricuspid valve re-operation and to discuss the application of tricuspid valve augmentation technique and related surgical techniques. Methods The clinical data of 23 children with tricuspid valve anterior mitral valvuloplasty underwent tricuspid valvuloplasty at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2006 to October 2015 were retrospectively analyzed. There were 15 males and 15 females 8 cases, the average age of 8.7 (5 ~ 15) years old. Intraoperative use of pericardial patch to expand the anterior tricuspid valve leaflets. After warfarin anticoagulant therapy to maintain the international standardization ratio (INR) 2.0 to 3.0. Results The duration of cardiopulmonary bypass was 87 ~ 132 (98.5 ± 35.7) min in all patients and 56 ~ 97 (68.40 ± 23.78) min in aorta. In-hospital death in 1 case, postoperative complications in 3 cases, including respiratory failure, renal insufficiency, right heart failure in 1 case, were cured after treatment. Followed up for 5 months to 10 years, an average of 3.5 years, 1 case died during follow-up, 6 cases of mild to moderate tricuspid regurgitation occurred in children, the rest of the children with good tricuspid valve function, no reoperation, no anticoagulation Related complications. Conclusion The application of tricuspid valve anterior valve augmentation, perioperative and postoperative follow-up in children who need to undergo tricuspid valve surgery again can achieve good near and mid-term curative effect.