İbrahim Çağrı KAYA, Merih ÖZBAYBURT, Mehmet ÖZGEYİK

Kombine Karotis, Aort Kapak Ve Koroner Arter Hastalığı Mevcut Zor Bir Olgu: Akılcı Bir Yaklaşım Ve Hasta Yönetimi

Halen tartışmalı olan ve farklı yaklaşımlar tercih edilen, kombine karotis ve kardiyak cerrahi yapılan hastamızı literatür eşliğinde sunuyoruz. Aort darlığı tanısı ile aort kapak replasmanı amacıyla yatırılan 65 yaşında erkek hasta; preop tetkiklerinde sol ana koroner arter lezyonlu koroner arter hastalığı ve bilateral semptomatik karotis arter hastalığı tespit edildi. Hastaya öncelikle servikal sinir blokajıyla uyanık olarak sağ karotis endarterektomi yapıldı. 48 saat yoğun bakım takibi sonrasında kardiyopulmoner bypass ve aortik kross klemp altında 21 numara metalik aort kapak replasmanı ve koroner arter bypass greftleme yapıldı. Peroperatif takipleri ve sonrasında 3 aylık kontrollerinde herhangi bir nörolojik hasar tespit edilmedi kardiyak açıdan stabil seyretti. Bu gibi durumlarda önce kardiyak cerrahiyi, önce karotis cerrahisini ya da her ikisini aynı seansta yapmayı tercih eden merkezler mevcuttur. Fakat en doğru tercihin bu vakada olduğu gibi hastanın mevcut kliniği, kardiyak hemodinamisi ve inme riskini değerlendirerek karar vermek olduğunu savunuyoruz.

Anahtar Kelimeler:

karotid endarterektomi, aort kapak replasmanı, kardiyopulmoner bypass

A Difficult Case With Combined Carotid, Aortic Valve and Coronary Artery Disease: A Rational Approach And Patient Management

We present our patient who underwent combined carotid and cardiac surgery. A 65-year-old male patient admitted for aortic valve replacement with the diagnosis of aortic stenosis; coronary artery disease with left main coronary artery and bilateral symptomatic carotid artery disease were detected. Right carotid endarterectomy was performed with cervical nerve blockage while awake. After 48 hours of ICU follow-up, aortic valve replacement and coronary artery bypass grafting were performed under cardiopulmonary bypass and aortic cross clamping. No neurological damage was detected during the peroperative follow-up and the 3-month follow-up visits. His cardiac hemodynamics was stable. In such cases, there are centers that prefer to perform cardiac surgery first, carotid surgery first, or both in the same session. However, we argue that the best choice is to make a decision by evaluating the patient's current clinic, cardiac hemodynamics and stroke risk, as in this case.

Keywords:

carotid endarterectomy, aortic valve replacement, cardiopulmonary bypass,

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