Şenol YAVUZ, Tahsin BOZAT, Kenar Selma TİRYAKİOĞLU, Tamer TÜRK, Hakan ÖZKAN, Osman TİRYAKİOĞLU

Aktif enfektif endokarditte ameliyat zamanlaması

Amaç: Değişik nedenlerle öncelikli veya acil olarak ameliyat edilen ve erken dönemde ameliyat edilmeyen aktif enfektif endokardit olguları karşılaştırıldı.Çalışma planı: Kalp kapağı tutulumu olan 19 olgu (14 erkek, 5 kadın; ort. yaş 30.8±12.3; dağılım 19-54) retrospektif olarak incelendi. Olguların beşinde aort kapak, sekizinde mitral kapak, altısında ise çoklu kapak tutulumu söz konusuydu. On dokuz olgunun 13�ünde (11 erkek, 2 kadın; ort. yaş 31.6±10) cerrahi girişim erken dönemde (ort. 5. günde) uygulandı. Dört olguya aort kapak replasmanı (ek olarak bir olguda mitral kapak onarımı), beş olguya mitral kapak replasmanı (ek olarak iki olguda triküspid kapak onarımı), dört olguya ise çift kapak replasmanı (ek olarak bir olguya triküspid kapak onarımı) yapıldı. Çalışmamızda erken dönemde ameliyata alınmayan altı olgu (3 erkek, 3 kadın; ort. yaş 29.3±15.5) vardı.Bulgular: Ameliyata alınan olguların tümünde kan kültürlerinde koagülaz (+) stafilokokus aureus üredi. Ayrıca bir olguda brusella aglütinasyonu (+) olarak saptandı. Ameliyat edilen bir olguda erken dönem paravalvüler kaçak (leakage) nedeniyle tekrar ameliyat uygulandı. Ameliyat mortalitesi yoktu. Erken dönemde ameliyata alınmayan olguları n ikisi tedavinin birinci haftasında kaybedildi. Tıbbi tedavi uygulanan diğer dört olgudan üçü ilk yıl içinde ameliyat edildi.Sonuç: Aktif enfektif endokardit ameliyat için yüksek risk oluştursa da, ameliyat kararı mümkün olduğunca erken verilmeli tıbbi tedavinin sonuçları beklenmemelidir.

Timing for surgical therapy in active infective endocarditis

Background: Patients with active endocarditis undergoing urgent or first priority surgery for various reasons were compared.Methods: Nineteen patients (14 males, 5 females mean age 30.8±12.3 years; range 19 to 54 years) with cardiac valvular involvement were retrospectively investigated. Five patients had aortic valve involvement, 8 patients had mitral valve and the remaining 6 had multivalve involvement. Surgery was performed to 13 (11 males, 2 females; mean age 31.6±10 years) out of 19 patients (68.4%) immediately in the early period (mean 5. day). We performed aortic valve replacement to 4 patients (1 patient had additional mitral valve repair), mitral valve replacement to 5 patients (2 patients had additional tricuspit valve repair), two valve replacement to 4 patients (1 patient had additional tricuspit valve repair). There were 6 patients (3 males, 3 females; mean age 29.3±15.5 years) who were not operated in the early term.Results: Coagulase (+) Staphilococcus aureus was recovered from blood cultures in all patients undergoing surgery. In addition, Brucella agglutination test was found positive in one patient. One patient was reoperated in the early period due to paravalvular leakage. There was no operative mortality. Two patients who were not operated in the early period died during the first week of medical therapy. Three out of four patients who received medical therapy, were operated in the first year.Conclusion: Although active infective endocarditis causes high risk for operation, operation decision must be taken as early as possible and results of medical therapy should not be waited.

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