發(fā)布時(shí)間：2018-03-09 05:12

  本文選題：主動(dòng)脈瓣成形　切入點(diǎn)：自體心包　出處：《中國(guó)循證兒科雜志》2017年04期 　論文類型：期刊論文

【摘要】：目的總結(jié)并分析以自體心包修復(fù)兒童先天性主動(dòng)脈瓣狹窄的手術(shù)方法和早期預(yù)后。方法納入2013年7月至2015年6月在復(fù)旦大學(xué)附屬兒科醫(yī)院行自體心包主動(dòng)脈瓣成形術(shù)的先天性主動(dòng)脈瓣狹窄患兒,收集患兒的一般資料,圍手術(shù)期情況,并發(fā)癥,術(shù)前、術(shù)中、術(shù)后和隨訪時(shí)的超聲心動(dòng)圖資料。結(jié)果符合本文納入標(biāo)準(zhǔn)的9例患兒進(jìn)入本文分析,男6例,女3例,年齡4月齡至9歲。術(shù)前超聲提示,三葉式和二葉式主動(dòng)脈瓣分別為3例和6例;重度狹窄6例,中度狹窄1例,重度狹窄伴中度返流2例。9例均以自體心包再造或擴(kuò)大主動(dòng)脈瓣瓣葉。術(shù)后即刻與術(shù)前超聲心動(dòng)圖比較:主動(dòng)脈瓣最大跨瓣壓差[(31.6±9.4)mm Hg vs(73.0±22.2)mm Hg,P=0.000]和主動(dòng)脈瓣平均跨瓣壓差[(15.8±18.3)mm Hg vs(35.8±18.3)mm Hg,P=0.004]均下降。術(shù)后隨訪24~48(32±8)月,無(wú)死亡和再干預(yù)病例,未見(jiàn)嚴(yán)重不良事件,未見(jiàn)主動(dòng)脈瓣重度狹窄或重度反流、升主動(dòng)脈狹窄或擴(kuò)張、主動(dòng)脈瓣瓣環(huán)狹窄與擴(kuò)張、瓣膜脫垂或瓣膜贅生物病例;3例患兒分別在隨訪18、24和12個(gè)月時(shí)出現(xiàn)瓣葉活動(dòng)僵硬,瓣葉開(kāi)放不完全。術(shù)后左室后壁厚徑均呈下降趨勢(shì);末次隨訪時(shí),8例患兒左室后壁厚徑Z值(Z-LVPWd)均下降至正常水平(2)。結(jié)論以自體心包修復(fù)主動(dòng)脈瓣可改善先天性主動(dòng)脈瓣狹窄患兒的血流動(dòng)力學(xué),手術(shù)風(fēng)險(xiǎn)低,術(shù)后早期療效可,避免或延緩兒童主動(dòng)脈瓣置換術(shù),減少施行ROSS手術(shù)機(jī)會(huì)。
[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 鹵9.4 mm Hg vs(73.0 鹵22.2 mm Hg] and aortic valve mean trans-valve pressure. The difference [15.8 鹵18.3mm Hg vs(35.8 鹵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.
【作者單位】： 復(fù)旦大學(xué)附屬兒科醫(yī)院心血管中心;
【分類號(hào)】：R726.5

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本文編號(hào)：1587122