小儿二尖瓣双孔成形术.pdfVIP

624 中华,bJb~b科杂志2OO7年12月第28卷第12期 Chin J Pediatr Surg，December 2007，V0I．28，N0．I2 · 临 床 研 究 · d,JL-．尖瓣双孔成形术 莫绪明 左维嵩 张儒舫 顾海涛 孙剑 仇万山 彭卫 戚继荣 沈立 钱龙宝 【摘要】 目的 探讨二尖瓣xX：fL成形术治疗儿童特别是婴幼儿二尖瓣关闭不全的临床可行性及 有效性。方法 对16例重度二尖瓣关闭不全的d,JL行二尖瓣双孑L成形术，并在术前、术中、术后利用 超声心动图对瓣膜进行评价。结果 全组体外循环时间(74．4±23．3)min，主动脉阻断时间(51．3± 17．1)min。术中及术后超声心动图检查提示，患儿二尖瓣口均无中度以上反流，无患儿须立即再次手 术，术后常规使用血管活性药物，所有患儿均在术后24 h内脱离呼吸机。全组患儿均存活，无灌注 肺、术后重度心衰等严重并发症发生。随访 10个月～4年，所有患儿心功能(NYHA)为I级，超声心 动冈显示双孑L成形瓣膜活动良好，无瓣口狭窄，跨瓣压差均≤5 mmHg，术后14例无瓣膜反流、无左 房增大，1例二尖瓣轻度反流，1例中度反流，无近远期死亡。术后常规行阿司匹林抗凝治疗3～6个 月。结论 双孑L瓣膜成形术治疗儿童重度二尖瓣关闭不全，修补后瓣膜形态稳定，早中期疗效满意， 双孑L成形术指数是一种简便而有效实用的参数。 【关键词】 二尖瓣闭锁不全；先天性心脏病；心脏外科手术 Double-oHrice technique for the treatment of congenital mitPaI valve insufficiency in children )Xu～ ruing，ZU()Wei一．song，ZHANGRll_}nng，GU Hai—tao，SUN Jian，QlUW。n—shan，PENG Wei，Ql Ji～ rong，SHEN Li，Q ～Long bao．Department of Cardiac’Surgery，Nanjing Children’s Hospital， Nan ing Medical[Iniversity，Na72 ing 210008，China [Abstract] 0bjective To evaluate the clinical outcome of the double-orifice technique for the treatment of mitral valve insufficiency in children．Methods Sixteen patients with severe mitral valve insufficiency underwent valve repair using the double-orifice technique．The condition of valve was as— sessed with echocardiography before，during and after the operation．Results The mean cardiopulmo— nary bypass time was 74．4 23．3 min and the aorta clamping time was 51．3 17．1min．There was no re— currence of mitral valve regurgitation．Al1 patients were weaned off ventilator within 24 hours postop— eratively．There were no hospital deaths．At the latest follow up，the heart function improved signifi— cantly in all patients(NYHA class I)．Echo Doppler assessment of valve showed stable valve function in 1 4 patients and mild or severe regurgitation in 2．There were no late stenosis of valve。no trans—valve pressure difference a