25 YAŞ VE ÜZERİ İZOLE SEKUNDUM ATRİYAL SEPTAL DEFEKTLİ HASTALARDA TEK MERKEZLİ CERRAHİ KAPAMA SONUÇLARIMIZ
Amaç: Erişkin yaşlarda tanı konulan konjenital kalp hastalıklarının %25-30'unu İzole sekundum tip atriyal septal defektler (ASD) oluşturmaktadır. İleri yaşlarda egzersiz intoleransı, atrial taşiaritmiler, sağ ventrikül disfonksiyonu ve pulmoner hipertansiyon gibi patolojilere sebep olarak morbidite ve mortalitede artışa sebep olabilirler.Gereç ve Yöntemler: 2006-2012 yılları arasında merkezimizde 25 yaş üzerinde transtorasik ekokardiyografide soldan sağa şant oranı 1,5'in üzerinde olan ve izole sekundum tip ASD tanısıyla opere edilen 26 hasta pulmoner arter basınçları, sol ventrikül ejeksiyon fraksiyonları, kardiyotorasik oranları, fonksiyonel kapasite değerleri, ekstübasyon zamanları, yoğun bakım ünitesinde ve hastanede kalış süreleri ile mortalite açısından retrospektif olarak incelendi.Bulgular: Ortalama ekstübasyon süresi 6.8±2.1 ve yoğun bakım ünitesinde kalış süresi 16.1±3.7 saat, hastanede kalış süresi 4.2±0.9 gün, New York Heart Associatıon (NYHA) sınıflamasına göre fonksiyonel kapasite preoperatif ortalama 2 , postoperatif 12. ayda ortalama 1 , kardiyotorasik oran değerleri preoperatif ortalama %59.8±4.6, postoperatif 12. ayda ortalama %57.7±5, preoperatif ortalama pulmoner arter basıncı (PAB) 38.9±9 mmHg iken postoperatif 12. ayda PAB 30.1±6.1 mmHg ve preoperatif ortalama sol ventrikül ejeksiyon fraksiyonu %58.9±2.3, postoperatif 12. ayda %68.5±2.6 olarak tespit edildi.Sonuç: Her yaş grubunda başarıyla icra edilebilen cerrahi primer ASD tamiri ile mortalite ve morbiditenin önüne geçilebilmektedir.
The Results of the Surgical Closure of Atrial Septal Defect Among the Patients Older than 25 Years Old in A Single Centre
Objective: 25-30% of the congenital heart diseases diagnosed in adult population is constituded by isolated secundum type atrial septal defect. At later ages it may contribute to an increase in mortality and morbidity by causing exercise intolerance, atrial tachyarrythmias, right ventricule dysfunction and pulmonary hypertension.Material and Methods: Pulmonary artery pressure, left ventricle ejection fraqtion, cardiothoracic index, functional capacity, extubation time, length of stay in intensive care unit and time of hospitalization of 26 patients, older than 25 years old, undergoing surgical operation in our medical centre between 2006 and 2010 with a diagnosis of isolated secundum type atrial septal were studied retrospectively.Results: Mean extubation time was 6.8±2.1 hours, length of stay in intensive care unit was 16.1±3.7 hours, time of hospitalization was 4.2±0.9 days. Preoperative functional capacity according to NYHA was 2 and was 1 on the postoperative 12th mounth. Cardiothoracic index was %59.8±4.6 preoperatively and was %57.7±5 on the postoperative 12th mounth. Preoperative mean pulmonary artery pressure was 38.9±9 mHg and was 30.1±6.1 mmHg on the postoperative 12th mounth. Left ventricle ejection fraction was %58.9±2.3 preoperatively and was %68.5±2.6 on the postoperative 12th mounth. Conclusion: It is possible to avoid the increase in mortality and morbidity with primary surgical repair of atrial septal defect , which is performed successfully to all patients of all ages.
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