婴幼儿先天性二尖瓣关闭不全的外科处理  

Surgical treatment of congenital mitral regurgitation in infants under 3 years of age

作　　者：柴文祥 丁旭龙 刘洁 李保军 孟东亮 臧永杰 钟后成 Chai Wenxiang;Ding Xulong;Liu Jie;Li Baojun;Meng Dongliang;Zang Yongjie;Zhong Houcheng(Department of Thoracic and Cardiovascular Surgery,Shenzhen University General Hospital,Guangdong Shenzhen 518055,China)

机构地区：[1]深圳大学总医院胸心外科,广东省深圳市518055 [2]联勤保障部队第988医院心胸外科,河南郑州市450042

出　　处：《中国体外循环杂志》2020年第3期168-170,182,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结3岁以下婴幼儿先天性心脏病(CHD)二尖瓣关闭不全(MR)外科处理的经验,探讨手术方式及手术效果。方法 2012年1月至2018年12月在本科手术治疗的3岁以下婴幼儿CHD MR患儿82例,其中男39例,女43例,平均年龄(13±3.6)月,平均体重(7.8±1.6)kg。患儿合并的其他畸形均同期矫治。结果术中绝大多数患儿成形效果满意,76例顺利停机,6例不能顺利停机,再次转机加做瓣环环缩成形术后顺利停机。手术成功率97.56%,术后ICU死亡2例,死亡原因为肺动脉高压危象和低心排血量综合征。术后半年随访超声心动图提示无或少量MR 74例,轻到中度MR 4例,中度MR 2例。结论 3岁以下婴幼儿MR病理变异较大,瓣膜交界缝合和瓣环环缩成形是主要手术方法,短期效果确实。Objective To summarize the experience of surgical treatment of congenital mitral regurgitation in infants under three years of age,and to explore the surgical methods and effects.Methods From January 2012 to December 2018,82 children with congenital mitral valve insufficiency who underwent surgery in our department,including 39 males and 43 females,with an average age of 13±3.6 months,and an average weight of 7.8±1.6kg.All other deformities were corrected at the same time.Results The majori⁃ty of patients had satisfactory results during surgery.A total of 76 patients were successfully weaned from cardiopulmonary bypass,and 6 patients could not be weaned from cardiopulmonary bypass smoothly.After another valve annulus angioplasty,they were successfully weaned from cardiopulmonary bypass.Two patients died after the operation due to pulmonary hypertension crisis and low cardiac out⁃put,and the success rate was 97.56%.A follow-up echocardiogram six months after the operation showed that 74 cases had no or trace mitral regurgitation,four cases had mild to moderate regurgitation,and 2 cases had moderate regurgitation.Conclusion Mitral regur⁃gitation in infants under three years of age has large pathological variations.Suturing the valve junction and annulus valvuloplasty are the main surgical methods,and the short-term effect is definite.

关 键 词：先天性心脏病 二尖瓣关闭不全 瓣膜成形术 婴幼儿 心肺转流 心脏手术 

分 类 号：R726.5[医药卫生—儿科]