小儿先天性心脏病二尖瓣关闭不全再次手术原因及处理  

Causes and management of reoperation for mitral regurgitation in children with congenital heart disease

作　　者：李斌[1] 刘爱军[1] 杨明[1] 范祥明[1] 苏俊武[1] Li Bin;Liu Aijun;Yang Ming;Fan Xiangming;Su Junwu(Department of Pediatric Cardiac Surgery,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏中心北京市心肺血管疾病研究所,100029

出　　处：《中华胸心血管外科杂志》2020年第8期461-464,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市自然科学基金项目(7202040)。

摘　　要：目的探讨小儿先天性心脏病二尖瓣关闭不全再次手术的原因和处理方法.方法回顾性分析24例先天性心脏病二尖瓣修复术后再次出现中-重度关闭不全患儿资料.年龄7个月~14岁,中位年龄6.7岁;体质量9.2~47.0 kg,中位体质量18.5 kg.其中再次行二尖瓣成形术(MVP)23例,二尖瓣置换术(MVR)1例.再次行二尖瓣成形术的患儿中部分型心内膜垫缺损修补术后7例,完全型心内膜垫缺损修补术后3例,二尖瓣成形合并其他心内畸形矫治术后11例,单纯二尖瓣成形术后3例.再次行二尖瓣置换术患儿为二尖瓣成形术后.再次手术的原因包括:瓣环扩大、瓣叶脱垂、瓣叶裂、瓣叶穿孔、原缝线撕脱和溶血.结果全组患儿无死亡.术中证实21例瓣环扩大,14例瓣叶裂,9例瓣叶脱垂,3例存在瓣叶穿孔,1例腱索松弛,1例腱索短缩,2例腱索缺失,3例原缝线撕脱.其中9例环缩瓣环,21例环缩交界,14例缝合瓣裂,3例穿孔修补,2例腱索移植,1例双孔成形,加用成形环2例,瓣膜置换1例.体外循环(129.8±69.9)min,阻断(69.1±41.1)min.出院时超声心动图提示微-少量反流21例,中量反流2例,大量反流1例.随访7~84个月.出院后6个月复查超声心动图,微-少量反流21例,中量反流3例.结论儿童二尖瓣关闭不全再次手术的主要原因多见于瓣膜病变的再次进展或者初次手术缝合不当引起,再次手术仍能取得较为满意的结果.Objective To explore the causes and management of reoperation for mitral regurgitation in children with congenital heart disease.Methods Twenty-four paLients required reoperation for moderate lo severe mitral regurgitation after mitral valve repair.The median age was 6.7 years,ranging 7 months to 14 years;and their median weight was 18.5 kg,ranging 9.2 to 47.0 kg.Among the patients who underwent reoperation for mitral insufficiency,mitral valvuloplasty was performed in 23 cases and mitral valve replacement was performed in 1 case.Reoperation for mitral valvuloplasty was performed in 7 cases after repair for partial endocardial cushion defect,3 cases after repair for complete endocardial cushion defect,11 cases after mitral valvuloplasty combined with other intracardiac malformations,3 cases after mitral valvuloplasty.Reoperation for mitral replacement was performed in 1 case after mitral valvuloplasLy.Reasons for reoperation included enlargement of annulus,prolapse of valves,cleft of valves,perforation of valves,avulsion of original suture and hemolysis.Results There was no early and later death during the follow-up.Enlarged mitral annulus in 21 cases,cleft valve in 14 cases,valve prolapse in 9 cases,valve perforation in 3 cases,relaxation of tendon chord in 1 case,shortening of tendon chord in 1 case,loss of tendon chord in 2 cases and avulsion of original suture in 3 cases were confirmed.Mitral annuloplasty,annular junction contraction,cleft closure,aberrant orifice closure,Chordae shortening or neo-chordae implantation,prosthetic ring and mitral valve replacement were performed in these cases.The mean cardiopulmonary bypass time and aorta clamp time were(129.8±69.9)min and(69.1±41.1)min.Echocardiograghy revealed slight and mild mitral regurgitation in 21 cases,moderate mitral regurgitation in 2 cases and severe mitral regurgitation in 1 case.During the follow-up for 7 to 84 months.Six months after discharge,21 cases showed slight and mild mitral regurgitation and 3 cases had moderate mitral regurgitation.Con

关 键 词：二尖瓣关闭不全 再次手术 二尖瓣成形术 先天性心脏病 

分 类 号：R726.5[医药卫生—儿科]