目的 探讨双孔成形术治疗小儿二尖瓣中-重度关闭不全中、远期效果.方法 收集2003年3月至2015年3月南京儿童医院102例行二尖瓣双孔成形术的患儿,均采用超声心动图对二尖瓣成形效果进行评价,分析随访结果.男48例,女54例;年龄2个月~12岁,平均(29.8±32.5)个月;体质量4.0~25.5 kg,平均(10.6 ±5.4)kg.均为二尖瓣中、重度关闭不全,合并三尖瓣中度以上反流9例.结果 全组住院死亡2例,生存者随访1个月~12年,随访期间失访10例.完成早期随访93例,其中二尖瓣中度反流6例,中重度反流5例,再手术5例,死亡2例;早期随访生存率97.8% (91/93),免手术率94.6%(88/93),二尖瓣中度及中度以上反流11.8%(11/93).中期随访55例,其中二尖瓣中度反流6例,重度反流4例,再手术3例,死亡2例;中期随访生存率96.4% (53/55),免手术率94.6%(52/55),二尖瓣中度及以上反流18.2%(10/55).远期随访26例,其中重度反流1例,再手术2例,无死亡,免手术率92.3%(24/26),二尖瓣中度以上反流7.7%(2/26).术后随访10年患儿总生存率(92.4±2.4)%,免除再手术率(77.7±6.4)%.结论 双孔成形术治疗小儿中-重度二尖瓣关闭不全疗效相对稳定,并发症相对较少,有良好的近远期临床效果.
Objective To analyze the operation of long-term effect of edge to edge mitral repair for mitral vavle moderateto-severe insufficiency in children retrospectively.Methods Clinical dates of 102 patients who underwent edge to edge mitrel valve repair in Nanjing Children's Hospital from March 2003 to March 2015 were collected.Postoperative thoracic echocardiography was adopted to observe the effect of mitral valve forming and evaluate the follow-up results.Results The whole group of 2 patients died in hospital,Followed up for 1 months to 12 years,during the follow-up of 10 patients were lost.The early fol low-up,medium-term follow-up and long-term follow-up were completed 93,55 and 26 cases,respectively.In the early followup,6 patients had recurrent moderate mitral regurgitation(MR),and 5 patients had recurrent moderate-to-severe MR and reoperated during the follow-up period,a total of 2 cases died.In the medium-term follow up,moderate and severe MR were found in 6 and 4 cases,respectively.Three patients accepted reoperation,two patients died.In the long-term follow-up,1 case had recurrent severe MR,2 cases had re-operation and had no death.Early survival rate was 97.8 % (91/93),avoid reoperation rate was 94.6% (88/93).The incidence of moderate or severe mitral regurgitation was 11.8% (11/93).Midtcrm survival rate was 96.4% (53/55),avoid reoperation rate was 94.6% (52/55),moderate or severe mitral regurgitation rate was 18.2% (10/55).Long-term follow-up have no death,avoid reoperation rate was 92.3 % (24/26),mitral valve moderate and above reflux rate was 7.7 % (2/26).The actuarial survival and freedom from MV reoperation rate was (92.4 ± 2.4) % and (77.7 ± 6.4) % at 10 years,respectively.Conclusion Edge to edge mitral repair in the treatment of children with moderate to severe mitral insufficiency had relatively stable curative effect,relatively fewer complications,and high long-term clinical effect.