Sedef TUNAOĞLU, Serdar KULA, Rana OLGUNTÜRK, Erkan İRİZ, Gürsel Levent OKTAR, Veli Yıldırım İMREN, Velit HALİT, Dilek ERER

The effects on pulmonary artery pressure of early surgical repair of ventricular septal defect in small children

Amaç: Ventriküler septal defektli pediatrik hastaların tedavisinde, defektlerin erken cerrahi onarımı gibi önemli değisiklikler olmustur. Bu çalısmanın amacı, izole ventriküler septal defektlerin erken kapatılmasının pulmoner arter basıncı üzerindeki etkilerinin arastırılmasıdır. Gereç ve Yöntem: Ocak 2001 - Ocak 2004 arasında ventriküler septal defect nedeniyle cerrahi tedavi uygulanan 49 hasta çalısmaya dahil edildi. Hatalar ameliyattaki yaslarına gore iki gruba ayrıldı. İki yasından once opera edilen hastalar Grup 1 (n=24), 2 yasından sonar opere edilenler Grup 2’yi (n=25) olusturdu. Preoperatif ve postoperatif (1.yıl) ekokardiyografik pulmoner arter basıncı değerleri tüm hastalar için kaydedildi. Bulgular: Preoperatif pulmoner arter basıncı ve pulmoner vasküler rezistans değerleri açısından grup 1 ve 2 arasında istatistiksel olarak anlamlı bir fark bulunmadı. Buna karsın, ortalama postoperative pulmoner arter basınç değerlerinin Grup 1’de (24,41 ± 0,63 mm-Hg) Grup 2 (37,06 ± 1,53mm-Hg) ile karsılastırıldığında belirgin olarak düsük olduğu gözlendi (p = 0.0001). Gruplarda ortalama iki yıllık izlem süresince erken veya geç mortalite olusmadı. Sonuç: Sonuçlarımız operasyonun erken yasta , pulmoner vasküler hastalık baslangıcından once daha yararlı olduğunu göstermektedir. Erken yasta, mümkünse infant döneminde cerrahi tedavi VSD’li hastalar için normale yakın bir yasam sürme sansı sağlayabilmektedir.

Küçük çocuklarda ventriküler septal defektin erken cerrahi onarımının pulmoner arter basıncı üzerindeki etkileri

Objective: Significant changes have occurred in the management of pediatric patients with ventricular septal defect such as early surgical repair of the defects. The objective of this study was to investigate the effects of early closure of isolated ventricular septal defects on pulmonary artery pressure. Materials and Methods: Forty-nine patients undergoing surgery due to ventricular septal defects between January 2001 and January 2004 were enrolled in the study. The patients were classified into two groups in terms of their age at the time of the operation. Those who had been operated on before the age of 2 formed Group 1 (n=24) and those who had been operated on after the age of 2 formed Group 2 (n=25). Preoperative and postoperative (at 1 year) echocardiographic measurements of pulmonary artery pressure values were recorded for all patients. Results: No statistically significant differences were found between groups 1 and 2 in terms of preoperative pulmonary artery pressure or pulmonary vascular resistance values. However, mean postoperative pulmonary artery pressure values were significantly lower in Group 1 (24.41 ± 0.63 mmHg) when compared with those in Group 2 (37.06 ± 1.53 mmHg) (p = 0.0001). No early or late mortality occurred in the groups during a mean follow-up period of 2 years. Conclusion: Our results suggest that surgery is more beneficial at an earlier age before the onset of pulmonary vascular disease. Surgery at an early age, if possible during infancy, may offer an opportunity to lead a nearly normal life for patients with VSD.

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