Fallot Tetralojisi Cerrahisinde Pulmoner Kapak Koruma: Pulmoner Akım Hemodinamikleri Erken Dönem Sonuçları

Giriş: Fallot tetralojisi en sık görülen siyanotik doğuştan kalp hastalığıdır. Çalışmada hastalığın güncel ve giderek daha çok tercih edilen tedavi seçeneği olarak pulmoner anülüs koruyucu cerrahi deneyimlerin paylaşılması ve literatüre katkı sağlanması amaçlanmıştır. Hastalar ve Yöntem: Çocuk kalp damar cerrahisi kliniğinde pulmoner kapak anülüsü korunarak cerrahi tam düzeltici onarım yapılan 30 çocuk hastanın verileri retrospektif olarak değerlendirildi. Hastaların demografik verileri, operasyon öncesi ekokardiyografi ve anjiyografi bulguları ve sonrasında tekrarlanan ekokardiyografi bulguları kaydedildi. Bulgular: Olguların 20 (%66.7)’si erkek, 10 (%33.3)’u kız; hasta ortanca yaşı 29 ay (10-212 ay) idi. İntraoperatif değerlendirmede 16 hastanın pulmoner kapak yapısının 2 (%53.3) yaprakcıklı, 14 hastanın ise 3 (%46.7) yaprakcıklı olduğu görülmüştür. McGoon indeksleri ekokardiyografi ile ortalama 1.82 ± 0.23; anjiyografik olarak ortalama 2 ± 0.29 olarak hesaplanmıştır. Pulmoner kapak anülüs Z skorları ekokardiyografi ile ortalama -1.8 ± 1.1; anjiyografik olarak ortalama -0.9 ± 1.2 saptanmıştır. Postoperatif 1, 7 ve 14. günlerde ekokardiyografi ile sağ ventrikül sistolik basınç ortalamaları sırasıyla 42.3 ± 6.5 mmHg, 38.7 ± 4.9 mmHg ve 35.8 ± 4.9 mmHg olarak ölçülmüş ve değerler arasında istatistiksel olarak anlamlı bir azalma tespit edilmiştir. Eşzamanlı bakılan pulmoner kapak gradientleri sırasıyla 27.2 ± 5.6 mmHg; 25.5 ± 6.2; 24.4 ± 6.2 mmHg saptanmış ve istatistiksel olarak anlamlı olarak düşüş olduğu görülmüştür. Ortalama 7.97 ± 3.39 ay takip süresince mortalite ve ciddi morbidite gözlenmemiştir. Sonuç: Fallot tetralojisi tedavisinde cerrahi sırasında pulmoner kapağın korunması erken ve geç dönem komplikasyonların azaltılması bakımından etkili bir tedavi seçeneğidir.

Anahtar Kelimeler:

Fallot tetralojisi, pulmoner subvalvüler darlık, pulmoner kapak darlığı

Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

Introduction: Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. We aimed to share our experience of pulmonary annulus preserving surgery as the current and increasingly preferred treatment option in this study. Patients and Methods: In this study, the data of 30 pediatric patients who underwent corrective repair by preserving the pulmonary valve annulus were evaluated retrospectively. Demographic data, angiographic, and echocardiographic findings before and after surgery were recorded. Results: In our study, 20 (66.7%) patients were male, 10 (33.3%) were female; median age of the patients was 29 months. In the preoperative evaluation, 16 patients had a pulmonary valve with two leaflets (53.3%), and 14 patients had three leaflets (46.7%). McGoon indexes calculated as mean 1.82 ± 0.23 by echocardiography and 2 ± 0.29 by angiography. Pulmonary valve annulus Z-scores were determined as mean -1.8 ± 1.1 echocardiographically and -0.9 ± 1.2 angiographically. Mean right ventricle systolic pressures measured in echocardiographic examination at 1st, 7th, and 14th days after surgery were 42.3 ± 6.5, 38.7 ± 4.9, and 35.8 ± 4.9 mmHg, respectively, and decreasing values were significant statistically. Pulmonary valve pressure gradients measured at postoperative 1st, 7th, and 14th days and found as mean 27.2 ± 5.6, 25.5 ± 6.2, and 24.4 ± 6.2 mmHg, respectively; this decrease was also statistically significant. There was no mortality or significant morbidity during the mean 7.97 ± 3.39 months follow-up period. Conclusion: Preservation of pulmonary valve during surgery is an effective treatment option in the treatment of tetralogy of Fallot in terms of reducing early and late complications and should become a more prevalent technique.

Keywords:

Tetralogy of fallot, pulmonary subvalvular stenosis, pulmonary valve stenosis,

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi