Görkem ÇİTOĞLU, Serhat Bahadır GENÇ, Hacer KAMALI, Fatma SEVİNÇ ŞENGÜL, İsmihan Selen ONAN

Çocuklarda Parsiyel Atriyoventriküler Septal Defekt Tamir Sonuçları

Giriş: Parsiyel atriyoventriküler septal defektin (pAVSD) onarımı sonrası sağkalım mükemmel olsa da reoperasyon halen sorun oluşturmaktadır. Sol atriyoventriküler kapak yetersizliği (SAVKY), reoperasyonun en sık nedenidir. Bu çalışmada, pAVSD onarımı yapılan hastaların verilerini retrospektif olarak analiz ederek morbidite ve mortalite oranlarını belirlemek amaçlanmıştır. Hastalar ve Yöntem: Merkezimizde 2011-2019 yılları arasında, pAVSD nedeniyle tamir yapılan 18 yaşından küçük toplam 25 hastanın takip verileri hastane kayıtlarından elde edildi. Down sendromu insidansı, ölüm, komplikasyonlar ve reoperasyon oranları analiz edildi. Bulgular: Ameliyat sırasında ortalama yaş 4.64 yıl idi. Daha geç yaşta ameliyat edilen hastalarda ameliyat öncesi SAVKY derecesi göreceli olarak yüksek bulunmuştur (p< 0.05). İki hastada (%8) Down sendromu vardı. Takip süresi 2-96 ay arasındaydı (ortalama: 33.48 ay). Perioperatif mortalite yoktu. Dört hastada (%16) ameliyat sonrası aritmi görülmüştür. Bir hastada (%4) kalıcı kalp pili implantasyonu gerektiren tam atriyoventriküler blok gelişmiştir. Operasyon sonrası geçen süre arttıkça postoperatif SAVKY oranının arttığı gözlenmiştir. Down sendromunun varlığının postoperatif SAVKY’ye karşı koruyucu olduğu görülmüştür (p< 0.05). İki hasta (%8) SAVKY nedeniyle reoperasyon geçirmiştir. İlk ameliyattan reoperasyona kadar geçen süre ortalama altı yıldır. Down sendromu, reoperasyon için risk faktörü olarak bulunmuştur (p< 0.05). Sonuç: PAVSD’nin onarımının mortalitesi düşük ve sonuçları iyidir. PAVSD tamirini takiben reoperasyon için en sık neden SAVKY’dir ve ilk operasyonun ardından geçen süre arttıkça yetersizlik oranı artar. Ayrıca hastanın ameliyat yaşı arttıkça ameliyat öncesi SAVKY oranı da yükselmektedir. Down sendromu postoperatif SAVKY açısından koruyucu iken reoperasyon için risk faktörüdür. Reoperasyon oranının yüksek olması yakın takip gerekliliğini ortaya koymaktadır.

Outcomes of Partial Atrioventricular Septal Defect Repair in Children

Introduction: Repair of the partial atrioventricular septal defect (pAVSD) has an excellent survival but reoperation is still an issue. Left atrioventricular valve regurgitation (LAVVR) is the most common reason for reoperation. This study aimed to retrospectively analyze the results of patients undergoing pAVSD repair to determine the morbidity and mortality rates. Patients and Methods: Follow-up data of a total of 25 patients younger than 18 years of age, who underwent pAVSD at our centre within the period from 2011 to 2019, were obtained from hospital records. The incidence of Down syndrome, death, complications and reoperation rates were analyzed. Results: Mean age at operation was 4.64 years. Preoperative LAVVR grade was found to be relatively high in patients who underwent surgery at an older age (p= 0.027). Two patients (8%) had Down syndrome. Follow- up ranged from 2 months to 96 months (mean: 33.48 months). There was no perioperative mortality. Arrhythmia were observed in 4 patients (16%) after the operation. One patient (4%) had complete AV block requiring permanent pacemaker implantation. The rate of postoperative LAVVR was observed to increase as the time elapsed after the operation increased. The presence of Down syndrome was observed to be protective against postoperative LAVVR (p< 0.01). Two patients (8%) had reoperation for LAVVR. The mean time from the initial operation to reoperation was six years. The absence of Down syndrome was found to be a risk factor for reoperation (p< 0.01). Conclusion: Repair of pAVSD is performed with low mortality and favourable outcomes. Most common reason for reoperation following the repair of pAVSD is LAVVR and regurgitation rate increases as the time elapsed following the initial operation increases. Furthermore, preoperative LAVVR rate becomes higher as the operation age of the patient increases. Down syndrome is protective in terms of postoperative LAVVR and its absence is a risk factor for reoperation. High reoperation rates suggest the requirement of close follow-up.

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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