Alper Sami KUNT, Osman Tansel DARÇIN, Salih AYDIN, Deniz DEMİR, Cüneyt ŞELLİ

Sol ventrikül anevrizmalarında cerrahi tedavi sonuçlarımız

Amaç: Sol ventrikül anevrizmalarının cerrahi tamiri hayat kalitesi ve uzun süre sağkalım üzerine olumlu etkileri vardır. Çalışmamız, kliniğimizde sol ventrikül anevrizma tanısı ile cerrahi tedavi uygulanan olguların erken dönem sonuçlarını sunmak amacıyla düzenlenmiştir. Gereç-Yöntem: Merkezimizde 2002 ve 2004 yılları arasında yaş ortalamaları 58.53 ± 10.78 yıl olan sol ventrikül anevrizmalı 17 olguya anevrizma onarımı uygulanmıştır. Olguların preoperatif, postoperatif ekokardiyografik olarak sol ventrikül ejeksiyon fraksiyonları LVEF değerlendirilmiştir. Olguların tümünde lineer plikasyon uygulanmıştır. Takiplerin tümü poliklinik kontrolleri ile yapılmıştır. Bulgular: Postoperatif en sık karşılaşılan komplikasyon 5 olguda % 29.41 tedavi gerektiren ventriküler ve atriyal aritmilerdir. Preoperatif olguların % 17.64 NYHA klas I-II ve % 82.35 ise NYHA klas III-IV olup ortalama sol ventrikül ejeksiyon fraksiyonu %33.39 ± 5.97 bulundu. Anteroapikal anevrizma 15 olguda % 88.23 ve posterobazal anevrizma 2 olguda % 11.76 saptanmıştır. Olguların tümünde koroner arter bypass cerrahisi uygulandı. Postoperatif izlemlerde olguların% 82.35’de fonksiyonel kapasiteleri NYHA klas I-II, % 17.64 NYHA klas III-IV olarak değerlendirilirken ve ortalama ejeksiyon fraksiyonu % 43.31 ± 4.26 olarak bulundu. Sonuç: Sol ventrikül anevrizmalarının onarımı revaskülarize edilen koroner arter sayısı fazlalığının, dolayısı ile multidamar koroner hastalığının önemli bir risk faktörü olmasına rağmen erken dönemde mortalite ve morbiditeyi azaltmaktadır.

Anahtar Kelimeler:

Sol ventrikül anevrizması, Koroner arter bypass cerrahisi, lineer plikasyon

Results of surgıcal treatment in patıents with left ventrıcular aneurysm

Background: Aneurysm repair is an important therapeutic intervention which improves the survival and life quality of patients with left ventricular aneurysm. In this study, we present our early results of patients with the left ventricular aneurysm which treated surgically. Methods: Between January 2001 and October 2002, 17 patients underwent surgical repair for postischemic left ventricular aneurysm. Fifteen 88.2% of the patients were male and mean age was 58.53 ± 10.78 years. Linear closure employed in all patients. Complete coronary revascularization was routinely added in all cases. Results: There was no early mortality. Low cardiac output developed in 5 % 29.41 patients and treated by inotropic agents and 2 of them intraaortic balloon pump support. Atrial fibrillation and ventricular arrhytmia developed in 5 29.41% of the patients and all of them converted to sinus rhythm with antiarhythmic agents. Average stay in intensive care unit and hospital stay were 2.83 ± 1.29 and 7.74 ± 2.14 days, respectively. Functional status improved in all patients. Conclusions: Regardless repair method left ventricular aneurysm repair combined with complete coronary revascularization can be performed safely with reliable improvements regarding survival and functional status.

Keywords:

Left ventricular aneurysm, Coronary artery bypass surgery, Lineer closure,

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Cooley DA, Collins HA, Morris GC, Chapman DW. Ventricular aneurysm after myocardial infarction. Surgical excision with use of temporary bypass. JAMA 167 1958, 557–560.
Dor V, Saab M, Coste P, Kornaszewska M, Montiglio F. Left ventricular aneurysm. A new surgical approach. Thorac Cardiovasc Surg 37 1989, 11– 19.
Jatene AD. Left ventricular aneurysmectomy. Resection or reconstruction. J Thorac Cardiovasc Surg 89 1985, 321–331.
Dor V, Sabatier M, Di Donato M, Maioli M, Toso A, Montiglio F. Late hemodynamic results after left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or diskinetic aneurysm of the left ventricle. J Thorac Cariovasc Surg 110 1995, 1291–1301.
Faxon DP, Myers WO, McCabe CH, Davis KB, Schaff HV, Wilson JW, Ryan TJ. The influence of surgery on the natural history of angiographically documented left ventricular aneurysm: the Coronary Artery Surgery Study. Circulation 74 1986, 110–118.
Lundblad R, Abdelnoor M , Svennevig JL. Repair of left ventricular aneurysm: surgical risk and long-term survival. Annals T Surg September 2003, Pages 719-725.
Burton NA, Stinson EB, Oyer PE et al: Left ventricular aneurysm. J Thorac Cardiovasc Surg.77 1989, 546-75.
Pasini S, Gagliardotto P, Punta G. et al., Early and late results after surgical therapy of postinfarction left ventricular aneurysm. J Cardiovasc Surg 39 1998, 209–215.
Sinatra R, Macrina F, Braccio M. et al. Left ventricular aneurysmectomy; comparison between two techniques; early and late results. Eur J Cardiothorac Surg 12 1997, 291–297.
Komeda M, David TE, Malik A, Ivanov J, Sun Z. Operative risks and long-term results of operation for left ventricular aneurysm. Ann Thorac Surg 53 1992, 22–28.
Ståhle E, Bergström R, Nyström SO, Edlund B, Sjörgren I, Holmberg L. Surgical treatment of left ventricular aneurysm–assessment of risk factors for early and late mortality. Eur J Cardiothorac Surg 8 1994, 67–73.
Tavakoli R, Bettex D, Weber A, Brunner H, Genoni M, Pretre R, Jenni R, Turina M. Repair of postinfarction dyskinetic LV aneurysm with either linear or patch technique. Eur J Cardiothorac Surg 22 2002,129–134.
Vauthey JN, BerryDW, Snyder DW,et al., Left ventricular aneurysm repair with myocardial revascularization: an analysis of 246 consecutive patients over 15 years. Ann Thorac Surg 46 1988,29–35.
Vural KM, Şener E, Özatik MA, Taşdemir O, Bayazit K. Left ventricular aneurysm repair: an assessment of surgical treatment modalities. Eur J Cardiothorac Surg 13 1998, 49–56.
Yusuf S, Zucker D, Peduzzi P, et al., Effect of coronary artery bypass graft surgery on survival: overview of 10- year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 344 1994, 563–570.
Vicol C, Rupp G, Fischer S, Summer C, Dietrich BH, Struck E. Linear repair versus ventricular reconstruction for treatment of left ventricular aneurysm: a 10-year experience. J Cardiovasc Surg 39 1998, 461–467.
Shapira OM, Davidoff R, Hilkert RJ, Aldea GS, Fitzgerald CA, Shemin RJ. Repair of left ventricular aneurysm: long-term results of linear repair versus endoaneurysmorrhaphy. Ann Thorac Surg 63 1997, 701–705.
Doss M, Martens S, Sayour S, Hemmer W. Long term follow up of left ventricular function after repair of left ventricular aneurysm. A comparison of linear closure versus patch plasty. Eur J Cardiothorac Surg 20 2001, 783–785.