Ross手术治疗儿童主动脉瓣病变的早期疗效再认识  

Gold in the dust:the re-evaluation of early surgical results of Ross procedure for aortic valve disease in children

作　　者：潘燕军 刘鑫荣 孙彦隽[1] 殷猛[1] 朱宏斌 张海波[1] Pan Yanjun;Liu Xinrong;Sun Yanjun;Yin Meng;Zhu Hongbin;Zhang Haibo(Department of Pediatric Thoracic and Cadiovascular Surgery,Shanghai Children’s Medical Center,Medical School of Shanghai Jiaotong University,Shanghai 200127,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,200127

出　　处：《中华胸心血管外科杂志》2021年第8期457-461,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市科委科技支撑项目(18441901900)。

摘　　要：目的回顾性分析Ross手术治疗儿童主动脉瓣病变的早期效果及经验总结。方法共16例患儿于2018年5月到2019年12月在我院行Ross手术,年龄(6.6±3.4)岁(1.8~12.2岁),主动脉瓣狭窄3例,主动脉瓣狭窄伴反流8例,主动脉瓣反流5例,其中2例合并心内膜炎。9例患儿有手术史:球囊扩张术7例,主动脉瓣交界切开术1例,主动脉瓣瓣叶延长成形术1例。6例患儿为两瓣畸形,1例患儿为四瓣畸形。结果无手术死亡,体外循环(193.8±66.9)min,主动脉阻断(125.9±29.7)min。术后使用呼吸机(58.0±42.4)h,监护室滞留(5.4±3.4)天,住院(25.9±18.7)天。6例并发低心排血量综合征,2例出现肝功能不全,经治疗后均好转。术后随访3~23个月,均生存。NYHA心功能Ⅰ级13例,Ⅱ级3例。主动脉瓣跨瓣压差(8.3±5.5)mmHg(3.7~26.6 mmHg),肺动脉瓣跨瓣压差(20.5±16.4)mmHg(6.8~62.1 mmHg)。主动脉瓣反流3例阴性,1例轻微,12例轻度。肺动脉瓣反流4例轻微,9例轻度,3例中度。结论Ross手术治疗儿童主动脉瓣病变可以取得较理想手术效果。Objective To study the surgical results of Ross procedure in pediatric patients.We report our early outcomes of the Ross procedure for congenital aortic valve disease.Methods Retrospective analysis was performed on all 16 children with congenital aortic valve disease that underwent a Ross procedure from May 2018 to December 2019.Three patients had aortic stenosis(AS),5 had aortic regurgitation(AR),and 8 patients had AS/AR.Two patients had endocarditis.Nine patients had prior aortic valve surgeries or interventions,7 had percutaneous balloon aortic valvuloplasty,1 had surgical valvotomy and 1 had aortic valve repair by cusp extension.Six patients had bicuspid and 1 had quadricuspid aortic valves.Results There was no early death.Mean CPB time was(193.8±66.9)min(range 123~359 min),mean aortic cross-clamping time was(125.9±29.7)(range 82-186 min).Mean ventilation time was(58.0±42.4)h(range 22.7-163.0 h),and mean ICU and hospital length of stay was(5.4±3.4)d(range 2-16 d)and(25.9±18.7)d(range 7-77d).Six patients developed low cardiac output syndrome and 2 patient had hepatic dysfunction,which all improved after treatment.Follow-up was complete in all patients from 3 to 23 months,and there was no late death.Thirteen patients were in NYHA gradeⅠ,and 3 in gradeⅡ.The peak gradients through the aortic valve and pulmonary valve were(8.3±5.5)mmHg(3.7-26.6mmHg)and(20.5±16.4)mmHg(6.8-62.1 mmHg),respectively.The aortic regurgitation was negative in 3 patients,trivial in 1 patient and mild in 12 patients.The pulmonary regurgitation was trivial in 4 patients,mild in 9 patients and moderate in 3 patients.Conclusion Ross procedure is a safe,effective surgical operation for congenital aortic valve disease in children>1-year of age.

关 键 词：ROSS手术 主动脉瓣狭窄 主动脉瓣反流 儿童 

分 类 号：R726.5[医药卫生—儿科]