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目的探讨二尖瓣双孔成形术治疗儿童特别是婴幼儿二尖瓣关闭不全的临床可行性及有效性。方法对16例重度二尖瓣关闭不全的小儿行二尖瓣双孔成形术,并在术前、术中、术后利用超声心动图对瓣膜进行评价。结果全组体外循环时间(74.4±23.3)min,主动脉阻断时间(51.3±17.1)min。术中及术后超声心动图检查提示,患儿二尖瓣口均无中度以上反流,无患儿须立即再次手术,术后常规使用血管活性药物,所有患儿均在术后24 h内脱离呼吸机。全组患儿均存活,无灌注肺、术后重度心衰等严重并发症发生。随访10个月～4年,所有患儿心功能(NYHA)为Ⅰ级,超声心动图显示双孔成形瓣膜活动良好,无瓣口狭窄,跨瓣压差均≤5 mmHg,术后14例无瓣膜反流、无左房增大,1例二尖瓣轻度反流,1例中度反流,无近远期死亡。术后常规行阿司匹林抗凝治疗3～6个月。结论双孔瓣膜成形术治疗儿童重度二尖瓣关闭不全,修补后瓣膜形态稳定,早中期疗效满意,双孔成形术指数是一种简便而有效实用的参数。
Objective To investigate the clinical feasibility and effectiveness of mitral valve mitral valve insufficiency in children, especially infants. Methods Twenty-six children with severe mitral regurgitation underwent mitral double-orifice angioplasty. Echocardiography was used to assess the valve before, during, and after surgery. Results The cardiopulmonary bypass time (74.4 ± 23.3) min and the aortic block time (51.3 ± 17.1) min. Intraoperative and postoperative echocardiography examination showed no mild or moderate reflux in children with mitral valve, no need to immediately reoperation in children, postoperative routine use of vasoactive drugs, all children were in 24 h after surgery Within the ventilator. All patients were alive, no perfusion lung, severe heart failure and other serious complications occurred. All patients were followed up for 10 months to 4 years. All children with NYHA were grade Ⅰ. Echocardiography showed well-formed double-orifice valves with no valve orifice stenosis. The transvalvular pressure difference was ≤5 mmHg. No postoperative 14 patients Valvular regurgitation, no left atrial enlargement, mild mitral regurgitation in 1 case, moderate reflux in 1 case, and no immediate or distant death. After routine routine aspirin anticoagulation therapy for 3 to 6 months. Conclusions Double hole valvuloplasty was used to treat severe mitral regurgitation in children. The shape of the valve was stable after repair. The curative effect was satisfactory in early and middle stages. The index of double hole plasty is a simple and effective parameter.