Abstract
Background.
Mitral insufficiency is important problem in pediatric cardiac surgery. Plastic reconstruction
often is not available in a case of solid valve dysplasia and leads to mitral prosthesis.
Material and methods.
The medical records of 49 children, median age 10,2±3,1 months (range 1 to
36 months), who had undergone mitral prosthesis were reviewed. Indication for surgery was severe insuffi
ciency in 29 and total in 20. Serial postoperative echocardiograms were analyzed for repeated measures of
linear and volume dimension.
Results.
There were three postoperative groups: with perfect, satisfactory and poor clinical and echocardio-
graphic results. Peak gradient in the first group was 5,8±1,4 mm Hg (range 5 to 14 mm Hg), second group —
14,8±3,2 mm Hg (range 14 to 19 mm Hg), third group — 25,8±5,5 mm Hg (range 20 to 27 mm Hg). Patients
in the first and second groups had significant linear and volume dimension decreasing. There was echo-fea
tured prosthesis dysfunction in the third group in 5 patients, their measures of linear and volume dimensions
decreased slightly.
Conclusions.
Regular follow-up examination requires for children with mitral prosthesis. Precision anti
coagulant therapy can effectively prevent thromboembolism and valve dysfunction. Continuous freedom
from reoperation can be achieved if patients are +2 mitral Z-SCORE.
References
1.
Бокерия Л.А., Каграманов И.И., Бондарев Ю.И.
Врожденная недостаточность митрального кла
пана. М.: НЦССХ им. А.Н. Бакулева; 2003.
2.
Дземешкевич С.Л., Стивенсон Л.У.
Болезни мит
рального клапана. Функция, диагностика и ле
чение. М.; 2000. 3.
Oppido G., Davies B., McMullan D.M.,
Cochrane A.D., Cheung M.M.H., D'Udekem Y.
et al.
Surgical treatment of congenital mitral valve dise
ase: Midterm results of a repair-oriented policy.
J. Thorac. Cardiovasc. Surg.
2008; 135: 1313—21.
4.
Елисеев Л.Е., Исаков С.В., Сухова И.В., Горде
ев М.Л.
Анализ непосредственных результатов
аннулопластики митрального клапана.
Вестник
хирургии им. И.И. Грекова.
2009; 5: 9—12.
5.
Бокерия Л.А., Подзолков В.П., Хассан Али, Ша
талов К.В., Ильин В.Н., Тхарин Д.
и др. Протези
рование клапанов сердца у детей: хирургичес
кий подход и реальные возможности.
Детские
болезни сердца и сосудов.
2004; 1: 73—81.
6.
Alexiou C., Galogavrou M., Chen Q., McDonald A.,
Salmon A.P., Keeton B.K.
et al. Mitral valve replace
ment with mechanical prostheses in children:
improved operative risk and survival.
Eur. J.
Cardiothorac. Surg.
2001; 20: 105—13.
7.
Rafii D.Y., Davies R.D., Carroll S.J.
Age less than
two years is not a risk factor for mortality after mitral
valve replacement in children.
Ann. Thorac. Surg.
2011; 91: 1228-34.
8.
Beierlein W., Becker V., Yates R. Tsang V., Elliot M.,
De Leval M.
et al. Long-term follow-up after mitral
valve replacement with in childhood: poor event-
free survival in the young child.
Eur. J. Cardiothorac.
Surg.
2007; 31: 860-5.
9.
Van Doorn C., Yates R., Tsang V., De Leval M.,
Elliot M.
Mitral valve replacement in children:
mortality morbidity and hemodynamic status up to
medium term follow up.
Heart.
2000; 84: 634-42.
10.
Masuda M., Kado H., Tatewaki H., Shiokawa Y.,
Yasui H.
Late results after mitral valve replacement
with bileaflet mechanical prosthesis in children:
evaluation of prosthesis-patient mismatch.
Ann.
Thorac. Surg.
2004; 77: 913-7.
11.
Feringa H.H., Shaw L.J, Poldermans D., Hoeks S.,
Van der Wall E.E., Dion A.E.
et al. Mitral valve
repair and replacement in endocarditis: a systematic
review of literature.
Ann. Thorac. Surg.
2007; 83:
564-70.
12.
Yoshimura N., Yamaguchi M., Oshima Y., Oka S.,
Ootaki Y., Murakami H.
et al. Surgery for mitral
valve disease in the pediatric age group.
J. Thorac.
Cardiovasc. Surg.
1999; 118: 99-106.
13.
Хамидов А.В.
Открытый атриовентрикулярный
канал: хирургическая анатомия, особенности
гемодинамики и результаты коррекции: Дис. ...
д-ра мед. наук. М.; 2002.
14.
Malhotra S.P., Lacour-Gayet F., Mitchell M.B.,
Clarke D.R., Dines M.L., Campbell D.N.
Reoperation for left atrioventricular valve regurgita
tion after atrioventricular septal defect repair.
Ann.
Thorac. Surg.
2008; 86: 147-52.
15.
Yu J., Guo H , Zhang G., Wu S , Song G., Sun W
Valve replacement in pediatric patients: a single cen
ter experience.
Chin. Med.
J.2011; 124: 218-22.
