本文選題：主動脈瓣成形　切入點：自體心包　出處：《中國循證兒科雜志》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兒童先天性主動脈瓣狹窄的手術(shù)方法和早期預后。方法納入2013年7月至2015年6月在復旦大學附屬兒科醫(yī)院行自體心包主動脈瓣成形術(shù)的先天性主動脈瓣狹窄患兒,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)后和隨訪時的超聲心動圖資料。結(jié)果符合本文納入標準的9例患兒進入本文分析,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大主動脈瓣瓣葉。術(shù)后即刻與術(shù)前超聲心動圖比較:主動脈瓣最大跨瓣壓差[(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,無死亡和再干預病例,未見嚴重不良事件,未見主動脈瓣重度狹窄或重度反流、升主動脈狹窄或擴張、主動脈瓣瓣環(huán)狹窄與擴張、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個月時出現(xiàn)瓣葉活動僵硬,瓣葉開放不完全。術(shù)后左室后壁厚徑均呈下降趨勢;末次隨訪時,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)論以自體心包修復主動脈瓣可改善先天性主動脈瓣狹窄患兒的血流動力學,手術(shù)風險低,術(shù)后早期療效可,避免或延緩兒童主動脈瓣置換術(shù),減少施行ROSS手術(shù)機會。
[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】： 復旦大學附屬兒科醫(yī)院心血管中心;
【分類號】：R726.5

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本文編號：1587122