轻中度及中度房室瓣膜反流在Fontan术后的预后和相关危险因素分析  

Prognosis and risk factors for mild to moderate or moderate atrioventricular valve regurgitation after Fontan operation

作　　者：彭永宣 刘旭[1] 洪海筏 张海波[1] 刘锦纷[1] 鲁亚南[2] PENG Yongxuan;LIU Xu;HONG Haifa;ZHANG Haibo;LIU Jinfen;LU Yanan(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,Medical School of Shanghai Jiao Tong University,Shanghai,200127,P.R.China;Department of Pediatric Cardiothoracic Surgery,Xinhua Hospital,Medical School of Shanghai Jiao Tong University,Shanghai,200092,P.R.China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127 [2]上海交通大学医学院附属新华医院小儿心胸外科,上海200092

出　　处：《中国胸心血管外科临床杂志》2021年第1期54-59,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的研究轻中度、中度房室瓣膜反流在Fontan术后的预后及危险因素。方法将2004~2018年房室瓣膜反流为轻中度、中度于本中心行Fontan术和瓣膜成形手术的34例患者作为成形组,在同期患者中以1∶1~2的比例匹配对照组患者65例。共入组99例,其中男64例、女35例,年龄(63.4±36.3)个月,体重(17.3±6.7)kg。反流程度评级下降≥1定义为反流明显改善。研究终点为死亡、Fontan拆除或房室瓣膜置换,研究的危险因素包括Fontan术式、房室瓣膜成形方法、心脏解剖等。结果随访时间1.5(0.3~4.0)年,死亡率15.2%。成形组34例,82.4%患者接受单一成形术式。部分性瓣环环缩最为常见(52.9%)。随着随访时间延长,全组患者瓣膜反流程度存在逐渐加重的趋势(r=0.352,P=0.000)。轻中度反流在Fontan术后自行改善,而中度反流没有。瓣膜成形可以改善中度反流术后的反流程度,不增加手术死亡率,8.8%患者反流明显下降。瓣膜成形手术对轻中度反流无效,会增加手术死亡率。结论房室瓣膜功能在Fontan术后呈现逐渐下降的趋势。瓣膜成形手术对中度反流有效,不增加手术死亡率,但改善程度有限,而对轻中度反流无效并增加手术死亡率。Objective To investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation(AVVR)after Fontan operation.Methods A total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve(AVV)repair between 2004 and2018 in our center were selected as an AVV repair group.The patients in the same period were matched as a control group by the ratio of 1:1-2.Finally 99 patients were included into this study,including 64 males and 35 females,with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg.Grades of AVVR decreased more than 1 was defined as significant improvement.Endpoints of the study were death,Fontan takedown,AVV replacement.Risk factors including Fontan procedures,AVV repair procedures,cardiac anatomy were analyzed.Results Patients were followed up for 1.5(0.3-4.0)years.Overall mortality was 15.2%.Most(82.4%)of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common(52.9%).With the extension of follow-up,the degree of AVVR in the whole group showed a gradually increasing trend(r=0.352,P=0.000).Mild to moderate AVVR improved spontaneously after Fontan operation,while moderate AVVR did not.AVV repair could improve the degree of AVVR after moderate regurgitation,without increasing the surgical mortality,and regurgitation significantly decreased in 8.8%patients.AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality.Conclusion AVV function shows a gradual downward trend after Fontan operation.AVV repair is effective for moderate AVVR,does not increase mortality,but the degree of improvement is limited.AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.

关 键 词：房室瓣膜反流 FONTAN手术 单心室 房室瓣膜成形 

分 类 号：R726.5[医药卫生—儿科]