Ameliyat Edilmiş Parsiyel-İntermediate Tip Atriyoventriküler Septal Defektli Hastalarımızın Sonuçları

Giriş: Bu çalışmada, Başkent Üniversitesi Tıp Fakültesinde 1996-2016 yılları arasında ameliyat edilen parsiyel ve intermediate tip atriyoventriküler septal defektli (AVSD) hastaların sonuçları değerlendirilmiştir. Hastalar ve Yöntem: Hastane dosyaları incelenerek hastaların ameliyat öncesi ekokardiyografi ve anjiyografi bulguları, ameliyat yaşları ve ağırlıkları, ameliyat teknikleri ve süreleri, down sendromu varlığı, postoperatif dönemdeki takip ve ekokardiyografi bilgileri kaydedilmiştir. Bulgular: Ameliyat edilen toplam 178 hastanın %41.6 (n= 74)’sı erkek, %58.4 (n= 104)’ü kızlardan oluşmuştur. Ameliyat sırasındaki yaş ortalamaları 47.09 ± 44.25 ay (median yaş 30 ay, 25. persentil 17 ay, 75. persentil 66.5 ay), ortalama vücut ağırlıkları 15.00 ± 11.22 kg (median 11 kg, 25. persentil 8.27 kg, 75. persentil 17 kg) olarak hesaplanmıştır. Hastalardan 152 (%85.3)’sinin parsiyel, 26 (%14.7)’sının intermediate tip AVSD hastaları olduğu belirlenmiştir. Hastaların %19.1 (34 hasta)’ini down sendromlu hastalar oluşturmuştur. %21.3’ünde ek kardiyak anomali tespit edilmiştir. Hastaların %14.6 (intermediate tip olan 26 hasta)’sı modifiye tek yama tekniği (wilcox) ile, %71.9 (128 hasta)’u perikard yama, %13.5 (24 hasta)’i perikard yama + annuloplasti yapılarak ameliyat edilmiştir. Hastaların %92.1’inin mevcut klefti kapatılmıştır. Hastaların ilk bir ay içindeki erken morbidite oranı %21.2 (35 hasta), erken mortalite oranı ise %5.6 (10 hasta) olarak hesaplanmıştır. Geç morbidite (> 1 ay) %17 (27 hasta), geç mortalite ise %1.2 (2 hasta) olarak hesaplanmıştır. En sık geç morbidite nedeni sol atriyoventriküler kapak yetersizliği, sol ventrikül çıkış yolu darlığı ve bu nedenle yapılan reoperasyonlardır (%15.2). Sonuç: Parsiyel AVSD’lerin ameliyat sonrası erken mortalite ve morbiditesi düşük olmasına rağmen sol atriyoventriküler kapak yetersizliği ve sol ventrikül çıkış yolu darlığı nedeniyle reoperasyon oranı hala yüksektir. Hastalara çok geciktirmeden iki yaş civarında tüm düzeltme ameliyatı yapılmalı ve reoperasyon gereksinimi açısından yakın izlem yapılmalıdır.

Outcomes of Operated Partial-Intermediate Atrioventricular Septal Defect Patients

Introduction: Follow-up results of patients with partial-intermediate atrioventricular septal defect (AVSD) operated in 1996-2016 at Baskent University are presented. Patients and Methods: Data obtained from hospital records consists of echocardiographic and angiographic details before surgery, age and weight at surgery, operative details, presence of Down’s syndrome, details of postoperative care, early postoperative and latest echocardiographic findings and hospitalization for reintervention. Results: One hundred seventy eight patient-files were reviewed including 41.6% (n= 74) male, 58.4% (n= 104) female patients. The mean age of patients were 47.09 ± 44.25 (median, 30; 25 and 75 percentiles, 17 and 66.5, respectively) months. The mean body weight during the operation was 15.00 ± 11.22 (median, 11; 25 and 75 percentiles, 8.27 and 17, respectively) kg. Study group included 152 patients (85.3%) with partial AVSD and 26 of patients (14.7%) with partial AVSD. A total of 39 patients (19.1%) were diagnosed with down syndrome. Associated cardiac anomalies were present in 21.3% of patients. Operative technique was modified single-patch technique (Wilcox) in 14.6% (26 patients), pericardial patch in 25.8% (128 patients) and pericardial patch and annuloplasty in 13.5% (24 patients). The cleft in the left atrioventricular (AV) valve was closed in 92.1% all of patients.The early mortality and morbidity in the postoperative first month were calculated as 5.6 and 21.2% and the late mortality (> 1 month) and morbidity rates were calculated as 1.2% and 17%, respectively. The most common cause of late morbidity was left AV valve insufficiency, left ventricular outflow tract obstruction and therefore reoperations (15.2%). Conclusion: Although the mortality and morbidity rates are low in partial AVSD operations, the rate of reoperations for left AV valve insufficiency and left ventricular outflow tract obstruction are still high. Patients should be done corrective surgery around age two and follow up should be performed in terms of reoperating requirement.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi