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目的探讨儿童机械瓣膜置换术的疗效。方法14岁以下病童施行心脏机械瓣膜置换术121例,先天性心瓣膜病89例,风湿性心瓣膜病29例,心内膜炎24例(其中21例为先天性或风湿性心脏病患儿)。行二尖瓣置换62例,主动脉瓣置换49例,三尖瓣置换6例,双瓣置换4例。共置换机械瓣膜125枚。术后患儿均接受华法林抗凝。术后随访通过问卷或门诊检查完成。结果住院死亡15例,病死率12．4％(15／121);失随访32例。74例平均随访时间10．5年,晚期死亡1例,再手术2例。大部分存活病人心功能(纽约心脏协会分级)Ⅰ级-Ⅱ级。结论大多数儿童可以植入较大规格的机械瓣膜,保证远期生长发育需要。儿童机械瓣膜置换住院病死率高,合理的抗凝治疗可能提高远期疗效。
Objective To investigate the effect of mechanical valve replacement in children. Methods Totally 121 children under 14 years old underwent mechanical heart valve replacement, 89 with congenital heart valve disease, 29 with rheumatic valvular heart disease and 24 with endocarditis (of which 21 were congenital or rheumatic heart disease child). 62 cases of mitral valve replacement, 49 cases of aortic valve replacement, tricuspid valve replacement in 6 cases, double valve replacement in 4 cases. A total of 125 mechanical valve replacement. All children received warfarin after anticoagulation. Postoperative follow-up by questionnaire or outpatient check completed. Results In-hospital death was 15 and the case-fatality rate was 12.4% (15/121). Follow-up was 32 cases. 74 cases were followed up for an average of 10.5 years, 1 died in late stage and 2 cases were operated on again. Most of the surviving patients with cardiac function (New York Heart Association grading) Ⅰ-Ⅱ level. Conclusion Most children can be implanted with larger mechanical valves to ensure long-term growth and development. Children with mechanical valve replacement hospital mortality, reasonable anticoagulant therapy may improve long-term efficacy.