Mehmet IŞIK, Ömer TANYELİ, Yüksel DERELİ, Erdal EGE, Niyazi GÖRMÜŞ

Akut ve Kronik Pulmoner Tromboembolide Cerrahi Tecrübelerimiz

Giriş-Amaç: Pulmoner emboli vakaları tedavi edilmediği takdirde ani ölüm, hayatı tehdit eden akut bir durum ya datrombüslerin pulmoner damar duvarında organize olmasına bağlı olarak kronik tromboembolik pulmonerhipertansiyon gelişir. Bu çalışmada, tüm dünyada belirli merkezler dışında çok fazla sayıda yapılmayan ve mortalitesiyüksek olan pulmoner tromboendarterektomi ameliyatı ile ilgili tecrübelerimizin paylaşılması amaçlandı.Yöntemler: Şubat 2007 - Temmuz 2018 tarihleri arasında kliniğimizde akut pulmoner emboli ve kroniktromboembolik pulmoner hipertansiyon tanılarıyla ameliyat edilen toplam 13 hasta çalışmaya dâhil edildi. Buhastaların 9’u acil 4’ü elektif olarak ameliyata alındı. Hastalara açık kalp ameliyatı şartlarında pulmonertromboendarterektomi cerrahi prosedürü uygulandı. Hastaların geriye dönük bilgileri hastane yazılım sistemindenelde edildi.Bulgular: Pulmoner tromboendarterektomi uygulanan hastaların 6’sı bayan 7’si erkekti. Ortalama yaş 58 (38-71)olarak bulundu. Risk faktörü olarak 7 hastada derin ven trombozu, 3 hastada yakın zamanda geçirilmiş cerrahi, 2hastada malinite, 5 hastada sigara kullanımı, 1 hastada behçet ve 1 hastada serebrovasküler olay öyküsü mevcuttu.Dört vaka, postoperatif 0-26 gün aralığında exitus oldu. Bunların 3’ü akut pulmoner emboli, 1’i kronik tromboembolikpulmoner hipertansiyon tanılı hastalardı.Sonuç ve Yorum: Pulmoner tromboendarterektomi uygulanan hastaların erken dönem pulmoner arter basınçlarındabelirgin düşüş izlendi. Kronik tromboembolik pulmoner hipertansiyon tanısı konan hastalar, kalıcı arteriopatigelişmeden, pulmoner tromboendarterektomi ameliyatı için cerrahi merkezlere erken dönemde yönlendirilmelidir.Akut pulmoner emboli tanısı alan hastaların cerrahiye verilme zamanlamasının önemli olduğu kanaatindeyiz. Gecikenve hipotansif şok tablosunda ameliyata alınan hastaların mortalitesi yüksek olmaktadır.

Our Surgical Experiences in Acute and Chronic Pulmonary Thromboembolism

Introduction-Aim: If cases of pulmonary embolism are not treated, sudden death, a life-threatening acute condition or chronic thromboembolic pulmonary hypertension develops due to the organization of thrombi in the pulmonary vascular wall. In this study, it was aimed to share our experiences about pulmonary thromboendarterectomy which is not performed much more than certain centers all over the world. Methods: A total of 13 patients with acute pulmonary embolism and chronic thromboembolic pulmonary hypertension who were operated between February 2007 and July 2018 were included in the study. Nine of these patients were operated urgently and 4 were electively operated. All patients underwent pulmonary embolectomy and endarterectomy under open heart surgery conditions. The retrospective information of the patients was obtained from the hospital software system. Results: Of the patients who underwent pulmonary thromboendarterectomy, 6 were female and 7 were male. The mean age was 58 (38-71). As a risk factor; 7 patients had deep vein thrombosis, 3 patients had recently undergone surgery, 2 patients had malignancy, 5 patients had smoking, 1 patient had behçet and 1 patient had cerebrovascular event. 4 cases were exitus in the 0-26 day range. Three of them were acute pulmonary embolism and 1 patient with chronic thromboembolic pulmonary hypertension. Conclusion-Comments: Early pulmonary artery pressures were significantly decreased in patients undergoing pulmonary thromboendarterectomy. Patients diagnosed with chronic thromboembolic pulmonary hypertension should be directed to surgical centers for pulmonary thromboendarterectomy without developing permanent arteriopathy. We believe that the timing of administration to patients diagnosed with acute pulmonary embolism is important. The mortality rate of patients who underwent surgery for delayed and hypotensive shock is high.

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