Cemil Zencir, Erdem Ali Özkısacık, Tünay Kurtoğlu, Selim Durmaz

Dev Aortokoroner Safen Ven Greft Anevrizmasının Kardiyopulmoner Bypass Kullanmadan Cerrahi Rezeksiyonu

Safen ven greftlerinin anevrizmaları koroner bypass cerrahisinin sık görülmeyen komplikasyonlarıdır. Bu anevrizmalar genellikle asemptomatik olmakla birlikte rüptür ile ani ölüme neden olabilmekte veya kardiyak boşluklar ve vasküler yapılara bası uygulayabilmektedirler. On sekiz yıl önce koroner bypass cerrahisi uygulanmış olan altmış üç yaşındaki erkek hasta göğüs ağrısı ile başvurdu. Hastada ayrıca geçirilmiş renal transplantasyon öyküsü bulunmaktaydı. Koroner anjiyografide sağ koroner artere ait safen ven greftinde anevrizma bulunduğu ve nativ sağ koroner arterin tıkalı olduğu görüldü. Bilgisayarlı tomografide safen ven greftinin dev yalancı anevrizmasının (130x100x100 mm) sağ atriyum ve ventriküle bası uyguladığı saptandı. Hastaya cerrahi tedavi uygulandı. Anevrizma, median sternotomi yaklaşımıyla ve kardiyopulmoner bypass (KPB) kullanılmadan rezeke edildi. Safen ven grefti anevrizmaları büyük boyutlara ulaşabilme potansiyeline sahiptir. Bu tip olgularda cerrahi tedavi öncelikli seçenektir. Koroner revaskülarizasyonun gerekli olmadığı olgularda cerrahi rezeksiyon KPB kullanılmadan yapılabilir.

Surgical Resection of a Giant Aortocoronary Saphenous Vein Graft Aneurysm without Performing Cardiopulmonary Bypass

Aneurysms of saphenous vein grafts are infrequent complications of coronary bypass surgery.Although these aneurysms are usually asymptomatic, they may lead to sudden death by rupture orcompression of cardiac chambers and vascular structures. A sixty-three year old male patient, who hadundergone coronary bypass surgery eighteen years ago, was admitted with chest pain. The patientalso had a history of renal transplantation. Coronary angiography revealed an aneurysm of thesaphenous vein graft to the right coronary artery and occlusion of native right coronary artery.Computed tomography demonstrated a giant (130x100x100 mm) saphenous vein graftpsudoaneurysm compressing the right atrium and ventricule. The aneurysm was approached through amedian sternotomy and resected without the use of cardiopulmonary bypass (CPB). Saphenous veingraft aneurysms can potentially reach large dimensions. In such cases, surgery is the choice oftreatment. Surgical resection can be performed without CPB when coronary revascularizaton is notneeded.

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