儿童孤立性二尖瓣反流标准化成形术中探查结果及术后中期随访结果分析  

Intraoperative findings and mid-term outcomes of standardized repair for isolated mitral regurgitation in children

作　　者：窦铮 毛凤群 马凯[1] 何奇彧 刘禹泽 林新杰 李守军[1] Dou Zheng;Mao Fengqun;Ma Kai;He Qiyu;Liu Yuze;Lin Xinjie;Li Shoujun(Pediatric Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;State Key Laboratory of Cardiovascular Disease,Beijing 100037,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外科中心,北京100037 [2]心血管疾病国家重点实验室,北京100037

出　　处：《临床小儿外科杂志》2024年第7期615-619,共5页Journal of Clinical Pediatric Surgery

基　　金：中央高水平医院临床科研业务费(2022-GSP-GG-19);北京市科技计划(Z201100005520001)。

摘　　要：目的初步探讨儿童孤立性二尖瓣反流的病因特点、术中探查结果及标准化二尖瓣成形术后中期随访结果。方法回顾性分析2020年1月至2023年12月在中国医学科学院阜外医院小儿外科中心接受二尖瓣标准化成形术的42例孤立性二尖瓣反流患儿资料, 男16例、女26例, 手术时年龄76.1 (45.2, 109.1)个月。主要终点事件为全因死亡和二尖瓣功能衰竭, 次要终点事件为围手术期严重并发症。结果术中探查发现, 除瓣环扩张外, 孤立性二尖瓣反流最常见的解剖病因为瓣下结构畸形, 共39例(39/42, 92.9%)。经过17.1 (11.9, 23.7)个月随访, 无一例发生围手术期严重并发症, 无一例死亡。3例术后出现二尖瓣大量反流, 其中2例行二尖瓣机械瓣置换, 1例目前仍接受药物治疗随访。对40例未接受机械瓣置换的患儿进行术前及随访结果的前后自身对照, 结果显示:术后左室射血分数[68.5 (64.0, 72.0)%比65.0 (61.5, 69.5)%]、左室舒张末期内径[+2.6 (+1.1, +4.5)比-0.1 (-0.9, +1.5)]显著低于术前(P<0.05), 二尖瓣反流程度较术前显著改善(Z=-5.715, P<0.05)。术后6个月、1年、3年免于主要终点事件概率分别为97.62%、95.05%、81.47%。结论孤立性二尖瓣反流的解剖结构异常主要集中于瓣下, 瓣下探查和处理是二尖瓣成形术中的关键技术。Objective To preliminarily investigate the etiological characteristics of isolated mitral regurgitation in children,intraoperative findings,and mid-term follow-up outcomes after standardized mitral valve repair.Methods A retrospective analysis was conducted on 42 cases of isolated mitral regurgitation in children who underwent standardized mitral valve repair at the Pediatric Cardiac Surgery Center,Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2020 to December 2023.There were 16 males and 26 females with a median age at surgery of 76.1(range:45.2 to 109.1)months.The primary endpoints were all-cause mortality and mitral valve dysfunction,and the secondary endpoints were severe perioperative complications.Results Intraoperative exploration revealed that,besides annular dilation,the most common anatomical cause of isolated mitral regurgitation was subvalvular deformity,observed in 39 cases(39/42,92.9%).During a median follow-up of 17.1(range:11.9 to 23.7)months,there were no severe perioperative complications or deaths.Three patients developed significant mitral regurgitation postoperatively,among whom 2 underwent mechanical mitral valve replacement,while 1 continues under medical management.A preoperative and follow-up self-comparison was conducted on the 40 patients who did not undergo mechanical valve replacement.The results showed that postoperative left ventricular ejection fraction and left ventricular end-diastolic diameter were significantly lower than preoperative values(P<0.05),and the severity of mitral regurgitation was significantly improved compared to preoperative levels(Z=-5.715,P<0.05).The rates of freedom from major endpoint events at 6 months,1 year,and 3 years postoperatively were 97.62%,95.05%,and 81.47%,respectively.Conclusions Anatomical abnormalities causing isolated mitral regurgitation predominantly involve subvalvular structures.Subvalvular exploration and management are crucial technical aspects of mitral valve repair.

关 键 词：先天性心脏病 孤立性二尖瓣反流 外科手术 儿童 

分 类 号：R65[医药卫生—外科学]