Düşük doğum ağırlıklı büyük arter transpozisyonu tanılı yenidoğanlarda arteryel switch ameliyatı-vaka serisi

Amaç: Düşük doğum ağırlığı ve/veya prematurite birçok doğumsal kalp hastalığında tam düzeltici cerrahi için mortalite ve morbidite açısından risk faktörü oluşturmaktadır. Biz bu çalışmada 2500 gramın altında arteriyel switch ameliyatı uyguladığımız büyük arter transpozisyonlu bebeklerin erken dönem sonuçlarını sunmak istedik. Gereç ve yöntem: Kliniğimizde son 4 yıl içinde 85 hastaya arteriyel switch prosedürü uygulanmıştır. Bunlardan 24 hasta 2500 gramın altında olup verileri retrospektif olarak incelenmiştir. Opere edilen hastaların ortalama yaşı ve vücut ağırlığı sırasıyla 9,3±4 gün ve 2282±141 gram olarak kaydedildi. Yirmi olguda izole arteriyel switch prosedürü, 3 hastada ek olarak VSD kapatılması ve bir olguda da ek olarak arkus rekonstrüksiyonu uygulandı. İki olguda tek koroner ostium anomalisi mevcuttu. Bulgular: Erken cerrahi mortalite gözlenmedi. Tüm olgularda sternum ameliyat çıkışında açık bırakılarak postoperatif ortalama 3. günde (1-14 gün) kapatıldı. Dokuz hastada (%37) ameliyat sonrası inotrop ihtiyacı oldu. Ortalama entübasyon süresi 12,9±21,9 gün olarak izlendi. Yoğun bakım izleminde iki olgu (%8,3) kaybedildi. Operasyondan sonra ortalama takip süresi 17±26,8 ay olarak gerçekleşti, geç mortalite gözlenmedi. Bütün olgular NYHA Class 1 olarak takip edilmektedir. Sonuç: Yenidoğan döneminin en sık karşılaşılan siyanotik hastalığı olan büyük arter transpozisyonlu bebeklerde düşük doğum ağırlığı ameliyat riskini arttırmaktadır. Biz de sınırlı sayıdaki vaka tecrübemizde 2000-2500 gram ağırlığındaki bu hastaların arteryel switch ameliyatına güvenli alınabileceğini düşünmekteyiz.

Arterial switch operation in low birth weight newborns with the diagnosis of transposition of the great arteries-case series

Purpose: Low birth weight and/or prematurity are known risk factors for mortality and morbidity in babies undergoing corrective surgery with the diagnosis of congenital heart diseases. In this study, we wanted to present our early results of arterial switch operation in babies with the diagnosis of transposition of the great arteries. Material and methods: In our clinic, 85 babies underwent arterial switch procedure during the last 4 years in center. Retrospective data of 24 patients out of 85 who had a body weight less than 2500 grams were evaluated. Mean age and body weight of the patients were 9.3±4 days and 2282±141 grams, respectively. Twenty patients underwent isolated arterial switch operation alone, whereas associated ventricular septal defects were closed in 3 patients and aortic arch reconstruction was performed in one. Single coronary ostium was encountered in two patients. Results: Early operative mortality was not encountered. Sternum was left open in all cases which was closed after a mean period of 3 days (1-14 days). Postoperative inotropic support was deemed mandatory in nine patients (37%). Mean intubation time was 12.9±21.9 days. Two patients (8.3%) died at the intensive care unit follow up period. Late mortality was not encountered. Mean follow up was 17±26.8 months and all the patients are doing well with NYHA Class 1 status. Conclusions: Low birth weight increases the operative risk in babies with transposition of the great arteries, which is the most common cyanotic heart disease in this population. In our limited experience, we believe that these patients with body weight of 2000 to 2500 grams may safely undergo arterial switch operation.

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