Gökmen AKKAYA, Çağatay BİLEN, Osman Nuri TUNCER, Mehmet Fatih AYIK, Yüksel ATAY

Surgical treatment of Ebstein anomaly: A unicenter experience

Aim: Ebstein anomaly is a rare congenital cardiac disorder that causing by failure of delamination of the tricuspid valve. Various surgical methods have been developed so far as treatment options. Our initial experience and short term follow up reported herein. Materials and Methods: Ten patients underwent surgical treatment with a diagnosis of Ebstein anomaly in our center between 2007 and 2017. Two patients underwent one and a half ventricle repair and Danielson method applied to eight patients. The X-clamping and cardiopulmonary by-pass (CPB) timing, duration in intensive care unit (ICU), extubation time and need for blood product were compared between Danielson and one and a half ventricle repair applied patients. Results: There was no mortality among patients. In the one and a half repair applied group both X-clamping (p=0.044) and CPB time (p=0.044) was longer compared to Danielson group. On the other hand there is no significantly difference between groups in ICU duration (p=0.400) or extubation timing (p=0.889). Furthermore, need for blood product and amount of drainage were not different between groups when two infant age cases were excepted while calculating. Conclusion: Danielson method is safe and effective in the repair of Ebstein anomaly and can be applied at infant age with similar clinical outcomes. Nevertheless, one and a half repair option is also beneficial in patients with a large size atrialized right ventricular volume. The last decision should be confirmed by heart team considering patient characteristics and surgeons’ past experience.

Ebstein anomalisinin cerrahi tedavisi: Tek merkez deneyimi

Amaç: Ebstein anomalisi triküspid kapak delaminasyonundaki yetersizlik sonucu oluşan nadir bir konjenital kalp hastalığıdır. Hastalığın tedavisinde farklı cerrahi yöntemler bugüne dek tanımlanmıştır. Bu çalışmada cerrahi deneyim ve kısa dönem cerrahi sonuçlarımızı belirtmekteyiz. Gereç ve Yöntem: Çalışmaya 2007-2017 yılları arasında merkezimizde Ebstein anomalisi tanısı ile opere edilen on hasta dahil edildi. İki hastaya bir buçuk ventrikül tamiri uygulanırken diğer sekiz hasta Danielson metodu ile opere edildi. Bu hasta grupları arasında kros klemp ve kardiyopulmoner by-pass zamanları ile yoğun bakım ve entübasyon süreleri ve kan ürünü replasman gereksinimleri karşılaştırıldı. Bulgular: Hastalarda mortalite gözlenmedi. Bir buçuk ventrikül tamiri uygulanan hastalarda Danielson uygulanan hasta grubuna göre hem kros klemp (p=0,044) hem de kardiyopulmoner by-pass süresi (p=0,044) daha az izlendi. Diğer yönden iki grup arasında yoğun bakım yatış süreleri (p=0,400) veya entübasyon süreleri (p=0,889) arasında anlamlı fark izlenmedi. Danielson ameliyatı uygulanan iki infant hasta hesaplamaya dahil edilmediği durumda yapılan karşılaştırmada, kan ürünü gereksinimi ve drenaj miktarlarında gruplar arasında belirgin fark izlenmedi. Sonuç: Danielson metodu, infant yaş grubunda Ebstein anomalisi tedavisinde diğer tanımlanmış tamir yöntemlerine benzer klinik sonuçlarla, güvenli ve etkin bir biçimde uygulanabilir. Yine de bir buçuk ventrikül tamir seçeneği geniş atriyalize ventrikülü olan hastalarda faydalı bir yöntemdir. Nihai karar hastanın karakteri ve cerrahi ekibin geçmiş tecrübeleri göz önüne alınarak kalp ekibi tarafından verilmelidir.

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