Ahmet BALTALARLI, İbrahim GÖKŞİN, Ufuk Ali TÜRK, Mansur ŞAĞBAN, Arif YILMAZ, Gökhan ÖNEM, Nagihan KARAHAN, Hakan KARA

Ağır fonksiyonal triküspid regürjitasyonu: "Modifiye semisirküler konstriktif anüloplasti" tekniği ve orta dönem sonuçları

Amaç: Bu yeni annuloplasti yönteminin amacı, De Vega annuloplastide görülen "Bow string fenomeni"ni oluşturan perianüler sütür ayrılmasını engellemek, dilate anulusta simetrik anüler redüksiyon ile ölçülü büzülme sağlamak ve annulusun fizyolojik hareket paternini korumaktır. Materyal ve Metod: Sol kalp romatizmal kapak hastalıklarına sekonder olarak gelişen ağır fonksiyonal triküspid regürjitasyonuna sahip 25 hasta çalışmaya dahil edildi. Annuloplasti için 0 No ve 2/0 No polipropilen sütür materyali kullanıldı. Sütürlerin herbiri mural anüler segmentin her iki ucunda anteroseptal ve posteroseptal komissüral bölgede fikse edildi ve düğümlendi. 2/0 No polipropilen sütür, 0 No polipropilen sütür ile birlikte serbest duvar annulusunu spiral şekilde total olarak sarmak için kullanıldı. 0 No polipropilen anüler redüksiyon ve konstriksiyon büzme için, 2/0 No polipropilen ise 0 No polipropilen sütürü anüler düzeyde fikse etmek amacıyla kullanıldı. Bulgular: Onaltı hastada (%66.7) triküspid regürjitasyonunun tümüyle ortadan kalktığı, 4 hastada (%16.7) 1°, 3 hastada (%12.5) 2°, 1 hastada (%4.2) ise 3° rezidüel triküspid regürjitasyonu olduğu görüldü. Atrial fibrilasyonlu 2 hastada (%8.4) ise hafif düzeyde (2.55 ve 2.8 mmHg) transvalvüler gradient tespit edildi. Bir hasta erken postoperatif dönemde düşük kardiyak output nedeniyle kaybedildi. Ortalama takip süresi 17.8 aydı. Sonuç: Bu yeni annuloplasti yöntemi kolayca yapılabilir. Üstelik, tekrarlanabilir bir yöntemdir ve maliyeti de düşüktür.

Severe functional tricuspid regurgitation: "Modified semicircular constrictive annuloplasty" technique and midterm results

Background: The aim of this new annuloplasty was to prevent the occurence of recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon as a result of gliding (jiggle) effect seen in De Vega annuloplasty, and to provide symmetrical annular reduction and constriction and also to protect the physiological movements of the annulus. Methods: Twentyfive patients, who had severe functional tricuspid regurgitation and operated for left sided rheumatic valvular disease, were included into this study. 0 No and 2/0 No polypropylene suture materials were used for this annuloplasty. Every one of both sutures were fixed and knotted at anteroseptal and posteroseptal comissural regions in both ends of free wall annulus. 2/0 polypropylene sutures coming from the anchoring points were used to wrap the free wall annulus itself totally as well as the 0 No polypropylene sutures in spiral fashion. For proper correction of regurgitation 0 No polypropylene sutures were used for reduction and constriction, 2/0 No polypropylene sutures were used for the fixation of 0 No polypropylene sutures in annular level. Results: Functional tricuspid regurgitation had improved totally in 16 patients (66.7%); 4 patients (16.7%) had 1°, 3 patients (12.5%) had 2° and only one patient (4.2%) had 3° residual tricuspid regurgitation in mid-term period. 2 patients (8.4%) had evolved transvalvular gradient (2.55 mmHg and 2.8 mmHg). One patient died from low cardiac output in early post operative period. Mean follow up period was 17.8 months (range between 1 and 32 months). Conclusion: This new annuloplasty can be performed easily. Moreover, this technique is reproducible and also cost effective.

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