Karaciğer sirozu nedeniyle takip edilen hastada aort ve mitral kapak replasmanında anestezi yönetimi
Kardiyopulmoner bypass (KPB) ile Child A, B ve C klasifikasyonuna girenlerde morbidite, Child C sınıfında ise mortalitenin arttığı bilinmektedir. Bu sunumda karaciğer sirozu nedeniyle takip edilen hastada KPB uygulanarak yapılan kapak replasmanlarından bahsedilmektedir. Alkole sekonder kronik karaciğer hastalığı (Child C) ile takip edilen 46 yaşındaki, erkek hasta infektif endokardit tanısıyla hospitalize edilerek mitral ve aort kapak replasmanları yapıldı. Kros klemp süresi 139 dk, KPB süresi 173 dk olan hastanın ameliyatı 4 saat sürdü. Postoperatif 21. saatte ekstübe edilen hasta, postoperatif 16. gün taburcu edildi. Child-Pugh C karaciğer sirozu olan hastalarda zorunlu olmadıkça anestezi ve cerrahiden kaçınılmalıdır. Bu hastalarda özellikle KPB yüksek mortalite hızları ile ilişkilidir. Child-Pugh C karaciğer sirozu ve infektif endokarditi olan hastamızda KPB eşliğinde başarılı çift kapak replasmanı için özetlenen perioperatif yaklaşımımız benzer olgular için yararlı bilgiler sağlayabilir.
Anesthesia management of a patient with liver cirrhosis and aortic-mitrale valve replacement
Cardiopulmonary bypass (CBP) carries a very high risk of morbidity in Child A, B and C and mortality in Child C. We report a case of acute infective endocarditis in a patient with hepatic cirrhosis who was treated successfully with mitral and aortic valve replacement with CPB. A 46-year-old male patient with alcohol-related liver cirrhosis (Child-Pugh class C) was admitted to the hospital for infective endocarditis, and mitral valve and aortic valve were replaced. The respective duration of aortic cross clamping, CPB and the operation overall were 139, 173 minute and 4 h respectively. In the intensive care unit the patient was extubated within 21 h and was discharged from the hospital after 16 days of operation. If it is not a must, anesthesiology and operation is not suggested on the patients having Child-Pugh C liver cirrhosis. Especially CPB is related to high mortality rates on this patients. Our summarized perioperative approach of successful replacement of double valve with CPB on our patient having Child-Pugh C liver cirrhosis would supply useful information on similar cases.
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