Abdurrahim ÇOLAK, Necip BECİT, Uğur KAYA, Munacettin CEVİZ

FARKLI YAŞLARDAKİ OPERE EDİLEN VSD'Lİ HASTALARIN DEĞERLENDİRİLMESİ

AMAÇ: Ventriküler septum defekt (VSD), sol ve sağ ventrikülü ayıran septuma yerleşen, bir ya da daha fazla sayıda olabilen açıklık olarak tanımlanabilir. Ventriküler septal defektler konjenital veya akkiz olabilir. En sık görülen doğuştan kalp anomalisidir. Bu yazımızda Kliniğimizde cerrahi olarak tedavi ettiğimiz VSD leri literatürler eşliğinde değerlendirdik.GEREÇ VE YÖNTEM: Kliniğimizde 68 VSD hastasına girişim yapıldı. 39 olgu erkek (%57.3), 29 olgu kadın (%42.7) idi ve yaş ortalaması 9,10±9,13(1-48) yaş/yıl, kilo ortalaması 25±16,5(7-75)kg olarak bulundu. Preoperatif NYHA fonksiyonel kapasite(FK) karşılaştırıldığında FK-I 31 olgu(%45,5), FK-II 30 olgu(%44,1), FK-III 7 olgu(%10,2) olarak belirlendi. Preoperatif anomali olarak en sık 15 olgu(%22,05) aort yetmezliği(AY) ve aort valf prolapsusu (AVP); 18 olgu(%26,4) ASD; 8 olgu(%11,7) PDA mevcuttu.BULGULAR: VSD tiplerine göre girişim yöntemlerine bakıldığında perimembranöz tipte en sık 53 olgu (%77,9) ile sağ atriotomi, 1 olgu(%1,4) sağ atriotomi ve triküspit septal annulus radial kesisi; müsküler tipte 8 olgu (%11,7) ile sağ atriotomi ve Swiss-Chess tip olan 2 olguda (%2,9) sol ventrikülotomi; DCJA( Doubly Committed Jukstaarteryel ) tipte 4 olgu (%5,8) ile sağ ventrikülotomi tercih edilmiştir. Postoperatif komplikasyonlar arasında en sık görülen 9 olgu(%15,3) ile rezidü VSD dir. Fatal seyreden 3 hastanın(%5,09) PAB 67±7,5mmHg; LV-RV şant 49±9,6mmHg; Qp/Qs 4,7±3,87; PVR 7,5±4,6 değerlerinin yüksek oldukları görülmüştür. Pre/postoperatif NYHA ve RVP karşılaştırıldığında istatistiki olarak anlamlı(p<0,05) olduğu görülmüş olup reoperasyonsuz yaşam olasılığı %93,2 olarak hesaplanmıştır.SONUÇ: Ventriküler septal defekt en sık görülen konjenital kalp hastalığıdır. Tanı ve sınıflandırılmasında EKO ve kardiak anjiografinin gelişiminin payı büyüktür. Defektleri çok iyi değerlendirip 3 aydan sonra kapatılması tercih edilmelidir.

Anahtar Kelimeler:

Sol ventrikül, İnterventriküler septum, Defekt, Left Ventricle, Interventricular septum, Defect

EVALUATION OF THE PATIENTS OPERATED WITH VSDs OF DIFFERENT AGES

OBJECTIVE: Ventricular septum defect (VSD) can be defined as one or more openings located in the septum separating the left and right ventricle. Ventricular septal defects can be congenital or acquired. It is the most common congenital heart anomaly. In this article, we evaluated the VSDs that we treated surgically in our clinic in the light of the literature.MATERIAL AND METHODS: 68 VSD patients were intervened in our clinic. 39 cases were male (57.3%) and 29 cases were female (42.7%). The mean age was 9.10 ± 9.13 (1-48), and the mean weight was 25 ± 16.5 (7-75). When the preoperative New York Heart Association (NYHA) functional capacity (FC) was compared, FC-I was determined as 31 cases (45.5%), FC-II as 30 cases (44.1%), and FC-III as 7 cases (10.2%). The most common preoperative existing anomalies were 15 cases (22.05%) with aortic insufficiency (AR) and aortic valve prolapse (AVP); 18 cases (26.4%) ASD and 8 cases (11.7%) with PDA.RESULTS: When looking at the intervention methods according to VSD types, the most common cases of perimembranous type were right atriotomy in 53 cases (77.9%), right atriotomy in 1 case (1.4%) and tricuspid septal annulus radial incision; 8 cases of muscular type (11.7%) and right atriotomy and left ventriculotomy in 2 cases (2.9%) of Swiss-Chess type; Right ventriculotomy was preferred in 4 cases (5.8%) of DCJA (Doubly Committed Jukstaarterial) type. Between postoperative complications the most frequent one was residual VSD in 9 patients (15.3 %). Mortality was seen in 3 patients (5.09 %) with preoperative PAB 67±7.5 mmHg, LV- RV shunt 49±9.6 mmHg, Qp/Qs 4.7±3.87, PVR 7.5±4.6 values in follow-up. According to the comparison of the pre/postoperative NYHA and RVP statistics (p<0.05), the survival rate without reoperation was estimated as 93.2 %.CONCLUSIONS: Ventricular septal defect is the most common congenital heart disease. The development of ECHO and cardiac angiography has a great share in the diagnosis and classification. It should be preferred to evaluate the defects very well and close them after 3 months.

Keywords:

ol ventrikül, İnterventriküler septum, Defekt Sol ventrikül, İnterventriküler septum, Defekt, Left Ventricle, Interventricular septum, Defect,

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