自体心包修复儿童主动脉瓣狭窄9例病例系列报告

发布时间：2018-03-09 05:12

本文选题：主动脉瓣成形　切入点：自体心包　出处：《中国循证儿科杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的总结并分析以自体心包修复儿童先天性主动脉瓣狭窄的手术方法和早期预后。方法纳入2013年7月至2015年6月在复旦大学附属儿科医院行自体心包主动脉瓣成形术的先天性主动脉瓣狭窄患儿,收集患儿的一般资料,围手术期情况,并发症,术前、术中、术后和随访时的超声心动图资料。结果符合本文纳入标准的9例患儿进入本文分析,男6例,女3例,年龄4月龄至9岁。术前超声提示,三叶式和二叶式主动脉瓣分别为3例和6例;重度狭窄6例,中度狭窄1例,重度狭窄伴中度返流2例。9例均以自体心包再造或扩大主动脉瓣瓣叶。术后即刻与术前超声心动图比较:主动脉瓣最大跨瓣压差[(31.6±9.4)mm Hg vs(73.0±22.2)mm Hg,P=0.000]和主动脉瓣平均跨瓣压差[(15.8±18.3)mm Hg vs(35.8±18.3)mm Hg,P=0.004]均下降。术后随访24~48(32±8)月,无死亡和再干预病例,未见严重不良事件,未见主动脉瓣重度狭窄或重度反流、升主动脉狭窄或扩张、主动脉瓣瓣环狭窄与扩张、瓣膜脱垂或瓣膜赘生物病例;3例患儿分别在随访18、24和12个月时出现瓣叶活动僵硬,瓣叶开放不完全。术后左室后壁厚径均呈下降趋势;末次随访时,8例患儿左室后壁厚径Z值(Z-LVPWd)均下降至正常水平(2)。结论以自体心包修复主动脉瓣可改善先天性主动脉瓣狭窄患儿的血流动力学,手术风险低,术后早期疗效可,避免或延缓儿童主动脉瓣置换术,减少施行ROSS手术机会。
[Abstract]:Objective to summarize and analyze the surgical methods and early prognosis of autologous pericardial repair of congenital aortic valve stenosis in children. Methods from July 2013 to June 2015, autologous pericardial aortic valve formation was performed in the Pediatrics Hospital of Fudan University. Congenital aortic valve stenosis, The data of general data, perioperative period, complications, echocardiography data of preoperative, intraoperative, postoperative and follow-up were collected. Results Nine children who met the criteria included in this study were included in the analysis, including 6 males and 3 females. The age ranged from 4 months to 9 years old. Preoperative ultrasound showed that there were 3 cases of trefoil aortic valve and 6 cases of two-leaf aortic valve, 6 cases of severe stenosis and 1 case of moderate stenosis. Two cases of severe stenosis with moderate regurgitation were treated with autologous pericardial reconstruction or enlargement of aortic valve lobe. Echocardiography immediately after operation compared with preoperative echocardiography: aortic valve maximum transvalvular pressure difference [31.6 卤9.4 mm Hg vs(73.0 卤22.2 mm Hg] and aortic valve mean trans-valve pressure. The difference [15.8 卤18.3mm Hg vs(35.8 卤18.3mm Hg] decreased. There were no severe adverse events, severe aortic stenosis or reflux, ascending aortic stenosis or dilation, aortic annulus stenosis and dilatation. In 3 cases of valve prolapse or valve vegetative disease, left ventricular posterior wall thickness decreased after 1824 and 12 months follow-up. At the last follow-up, Z value of left ventricular posterior wall thickness and Z value of Z-LVPWd all decreased to normal level. Conclusion Autologous pericardial repair of aortic valve can improve hemodynamics of children with congenital aortic valve stenosis, the risk of operation is low, and early postoperative curative effect can be achieved. To avoid or delay aortic valve replacement in children and reduce the chance of ROSS operation.
【作者单位】：复旦大学附属儿科医院心血管中心;
【分类号】：R726.5

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