二尖瓣成形技术治疗儿童Barlow病的早期疗效  

Short-term outcomes of mitral valvuloplasty for Barlow disease in children

作　　者：董硕 段亚冰 孙阳雪 徐海涛[1] 王菊[1] 杜楚豪 高漫辰 闫军[1] DONG Shuo;DUAN Yabing;SUN Yangxue;XU Haitao;WANG Ju;DU Chuhao;GAO Manchen;YAN Jun(Department of Pediatric Cardiac Surgery,National Center for Cardiovascular Disease and Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿心脏外科,北京100037

出　　处：《中国胸心血管外科临床杂志》2021年第3期349-353,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划(2017YFC1308100)。

摘　　要：目的总结二尖瓣成形技术治疗Barlow病合并二尖瓣中度以上反流患儿的临床疗效。方法回顾性分析2014年1月至2019年8月阜外医院10例Barlow病合并二尖瓣中度以上反流≤18岁患儿的临床资料,其中男3例、女7例,平均年龄(8.7±7.9)岁。术前超声心动图和术中瓣膜分析均证实二尖瓣瓣叶冗长、甩动,瓣叶及对合缘凸入左心房且高于二尖瓣瓣环水平,二尖瓣瓣环扩张,瓣下乳头肌、腱索冗长,术后病理可见瓣叶及腱索黏液样改变及部分纤维灶增生改变。二尖瓣修复技术包括人工瓣环植入技术、人工腱索植入技术、后叶Sliding技术、后叶部分切除(不包括Sliding技术)、瓣叶折叠、腱索折叠、乳头肌劈开、瓣环环缩(不包括人工瓣环植入)。分析二尖瓣修复技术、术后早期临床结果及随访超声心动图资料。结果所有患儿均成功完成了二尖瓣修复。平均主动脉阻断时间为(73.2±17.4)min,体外循环时间为(99.5±19.8)min。围手术期无患儿再次行手术治疗。1年、5年生存率分别为100.0%、100.0%。1年、5年无中度以上二尖瓣反流的发生率分别为90.0%、72.0%。结论对于Barlow病合并二尖瓣大量反流的婴幼儿,考虑到其病变重、操作空间小、需满足生长发育的特点,建议采用不同于大龄儿童的手术技术,如瓣环环缩术、腱索折叠技术,必要时采用"缘对缘"缝合术,可取得良好的早期效果,其中远期效果仍待进一步随访观察。大龄儿童可应用类似成人的Barlow二尖瓣成形技术方法,包括人工瓣环植入、瓣叶部分切除、人工腱索植入等。Objective To explore the clinical effect of mitral valvuloplasty on children with Barlow disease combined with moderate to severe or severe mitral regurgitation.Methods The clinical data of 10 patients with Barlow disease combined with moderate to severe or severe mitral regurgitation in Fuwai Hospital from January 2014 to August2019 were analyzed retrospectively,including 3 males and 7 females,with a mean age of 8.7±7.9 years.Echocardiography before and during the operation confirmed that the mitral valve leaflets were long and swinging,the valve leaflets and the opposite edge protruded into the left atrium and were higher than the level of the mitral valve rings,the mitral valve rings were dilated,the papillary muscles and tendons were long,and the pathological changes after the operation showed mucoid degenertion of the valve leaflets and tendons,and some fibrous foci hyperplasia.Mitral valve repair included implantation of artificial valve ring,implantation of artificial tendon,posterior leaflets sliding,partial resection of posterior leaflets(excluding sliding),valve leaflets folding,tendon folding,papillary muscle splitting and annular valve contraction(excluding artificial valve ring implantation).The technique of mitral valve repair,early clinical results and follow-up echocardiographic data were analyzed.Results All the patients successfully completed the mitral valve repair.The mean time of aortic occlusion was 73.2±17.4 min,and cardiopulmonary bypass time was 99.5±19.8 min.At the same time,4 patients received tricuspid valve repair and 1 funnel chest correction.There was no reoperation in perioperative period.The 1-year and 5-year survival rates were 100.0%and 100.0%,respectively.The incidence of below moderate mitral regurgitation was 90.0%at postoperative 1 year and 72.0%at postoperative 5 years.Conclusion For the young children who have Barlow disease and mitral regurgitation,considering the characteristics of heavy lesions,small operation space,and the need to meet the growth and development of

关 键 词：Barlow病 二尖瓣成形技术 儿童 腱索折叠 手术 

分 类 号：R726.5[医药卫生—儿科]