Kardiyak Tamponadlı Hastaların Torakoskopik Perikardiyal Pencere Açılma Tarafı Önemli mi?

Giriş: Çalışmamızda, kardiyak tamponadlı (KT) hastalarda sol taraf perikardiyal pencere (SoPP) ve sağ taraf perikardiyal pencere (SaPP) açılmasının avantajlarını ve dezavantajlarını değerlendirmeyi amaçladık. Hastalar ve Yöntem: Retrospektif olarak Ocak 2011-Aralık 2018 yılları arasında perikardiyal pencere (PP) açılması amacıyla 3. basamak merkez kardiyoloji kliniğinden kliniğimize sevkedilen kayıtlı 168 olgu değer lendirildi. 168 olgudan 31 olgu ileri evre akciğer kanseri ve 23 olgu tekrarlayan KT nedeniyle toplam 54 olgu çalışmaya alındı. Bütün hastalara, genel anestezi indüksiyonunda ve perikardiyal pencere açılması esnasında oluşabilecek instabiliteyi önlemek amaçlı videotorakoskopik PP operasyonu öncesi ekokardiografi eşliğinde perkutanöz perikardial drenaj uygulandı. Bulgular: Yaş, cinsiyet, vücut kitle indeksi, semptomlar, perikard patolojileri, hastanede yatış süreleri, preope rativ perikardial effüzyon ölçümleri, operasyon süreleri, preoperativ ejeksiyon fraksiyonları, göğüs tüp drenaj süreleri ve perikardiyal sıvı drenaj volümleri arasında iki grup arasında anlamlı farklılık saptanmadı. Kompli kasyon oranı SaPP grubunda anlamlı derecede düşük izlendi. Ventriküler yetmezlik SaPP grubunda görülmedi. Sonuç: PP komplikasyonları literatürler eşliğinde kapsamlı incelendikten sonra sol ventriküler yetmezliğin, girişim yapılan taraf dışında SoPP olup SaPP gelişmemesine sebep olabilecek başka uygun neden bulunamadı. PP operasyonuna alınan KT hastalarda sol ventriküler yetmezlik riskini azaltmak için sağ taraf yaklaşımının göz önüne alınması düşünülebilir.

Does the Thoracoscopic Pericardial Fenestration Side Matter in Patients With Cardiac Tamponade?

Introduction: In our study, we aimed to analyze and compare left pericardial fenestration (LPF) with right pericardial fenestration (RPF) in order to reveal the possible advantages or disadvantages in patients with cardiac tamponade (CT). Patients and Methods: Between January 2011 and December 2018, the medical records of 168 patients re ferred from the cardiology department of our tertiary central hospital for surgical pericardial fenestration (PF) were reviewed retrospectively. Out of the 168 patients, 54 patients consisting of 31 patients with advanced stage cancer with CT and 23 patients with recurrent CT were included into the study. All patients were provid ed with percutaneous, echocardiographic-guided drainage prior to video-assisted thoracoscopic surgical PF to avoid instability associated with the induction of general anesthesia and opening of the pericardial window. Results: There was no significant difference between the two groups in terms of age, sex, body mass index, symp toms, pericardium histology, length of hospital stay, preoperative measurement of pericardial effusion, operative time, preoperative ejection fraction, duration of chest tube drainage, and volume of pericardial fluid drainage. Complication rate was significantly lower in the RPF group. There was no reported ventricular failure in RPF. Conclusion: After a sweeping highlight of the literature examining the complications of PF, we did not find an eligible reason other than the intervention side for experiencing LV failure in LPF and not in RPF. We hypothesize that to reduce the risk of LV failure, right-sided intervention may be considered in patients with CT who will undergo surgical PF.

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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