儿童心脏瓣膜置换术(15例临床分析)

目的 总结1982年3月至2002年3月15例儿童心脏瓣膜置换术的经验，探讨儿童瓣膜置换的手术指征、瓣膜选择、手术技术和术后抗凝治疗等问题。方法 全组15例中11例为先天性病变。在中低温体外循环下手术，二尖瓣置换10例，主动脉瓣置换3例，三尖瓣置换1例，双瓣置换1例。均采用机械瓣。手术同期矫正其他先天性畸形。术后常规应用华法令抗凝。结果 无手术及住院死亡。随访1月～20年，晚期死亡2例，其余病人心功能均为I级，无心律失常，未发现有感染、出血或血栓等并发症，瓣膜功能良好。结论 儿童心脏瓣膜置换术采用机械瓣效果良好，术后抗凝治疗应个体化，低强度抗凝是安全可靠的。

Valve Replacement in Children (Report of 15 Cases)

Purpose To review our twenty year experience with valve replacement in children. Methods From March 1982 to March 2002, 15 patients aged 7-15 years underwent valve replacement with mechanical prostheses in our hospital. Of the 15 patients, 11 had congenital valve lesion. Operation was performed under moderate hypothermic cardiopulmonary bypass. Mitral valve replacement was performed in 10 patients, aortic valve in 3, tricuspid in 1, double valve in 1. Concomitant cardiac defects were corrected simultaneously. Postoperative anticoagulation was achieved by warfarin. Results There were no hospital deaths and surgical deaths. The follow up was done from 1 month to 20 years. All the patients survived had a NYHA class I. Of the survival there were no arrhythmia, intracardiac infection, bleeding, thromboenbolism or prosthesis dysfunction during the follow up period. Conclusions Valve replacement with mechanical prostheses can be performed with good outcome in children. Postoperative anticoagulation should be individualized. Long term anticoagulation with lower level is safe and acceptable in children.