Kaan KIRALİ, Başar SAREYÜPOĞLU, Vedat ERENTUĞ, Deniz GÖKSEDEF, Esat AKINCI, Cevat YAKUT, Gökhan İPEK, Mustafa GÜLER

Bayan hastalarda sağ anterior torakotomi ile atriyal septal defekt onarımı

Amaç: Sternotomi ile atriyal septal defekt onarımı düşük riskle gerçekleştirilen standart bir işlemdir. Kozmetik kaygılar ön plana alındığında sağ anterior torakotomi özellikle bayan hastalarda alternatif bir yaklaşımı oluşturur. Kliniğimizde kozmetik nedenlerle bayan hastalara uyguladığımız torakotomi ile atriyal septal defekt onarımının güvenilirlik derecesini, klinik sonuçlarını ve hasta memnuniyeti üzerine olan etkilerini inceledik. Materyal ve Metod: 1996-2003 yılları arasında kliniğimizde atriyal septal defektlerin tüm tipleri için sağ anterior torakotomi ile opere edilen, yaş ortalaması 25.4 ± 10.7 olan 40 hasta peroperatif ve uzun dönem sonuçları ile (ortalama takip süresi: 40.6 ay) retrospektif olarak analiz edildi. Operasyon tekniğinde torakotomiye uygun sınırlı cilt insizyonu, meme bezi dokusunun korunması, frenik sinir hasarının önlenmesi ortak özelliklerdi.Bulgular: Güvenli cerrahi saha sağlanamaması nedeniyle bir hastada sternotomiye dönüldü. Femoral kanülasyon yapılan iki hastada femoral laserasyona bağlı düzeltici işlem, bir hastaya kanama revizyonu gerekti. Erken dönemde 2 hasta torakotomiye sekonder şiddetli interkostal nöralji nedeniyle analjezik tedavi aldı. Hastane kalış süresi ortalama 4.06 gündü. Postoperatif dönemde bir hastada hafif mitral kapak yetersizliği (ostium primum tip defekte bağlı) gözlenirken, görüşmelerde kozmetik memnuniyetin %91.2 düzeyde sağlandığı, %6.7 hastanın ise kararsız kaldığı saptandı. 2 hasta (%2.5) insizyon hattı boyunca yaygın skar gelişiminden şikayetçiydi. Üç hastada meme asimetrisi mevcuttu. Hastaların (%85 hasta) median sternotomiyi operasyon tekniğinde tercih etmeyeceğini belirtti.Sonuç: Sağ anterior torakotomi atrial septal defektlerin onarımında güvenilir sonuçları, yüksek hasta memnuniyeti ile seyreden bir yaklaşım olup genç bayan hastalarda tercih edilecek bir yöntemdir.

Closure of atrial septal defects with anterior thoracotomy in female patients

Background: The closure of atrial septal defect via sternotomy is a standart procedure performed with low risk. Right anterior thoracotomy is an alternative approach by needs of cosmetic aspects in female patients. We aimed to evaluate safety of the procedure, clinical results and patients’ satisfaction for minithoracotomy cases that are performed in our clinic with regards to cosmetic aspects of female patients. Methods: Between the years 1996 and 2003 perioperative and long term follow up (mean follow-up time:40.6 months) of 40 female patients (with mean age 25.4) operated in our clinic for all types of atrial septal defects were analysed retrospectively. Special futures of the operation technique consisted of limited skin incision, protection of mammarian gland, prevention of phrenic nerve injury.Results: Conversion to sternotomy was needed in one patient because of inappropriate exploration. Rethoracotomy was performed in one patient because of postoperative bleeding. Two patients needed analgesic medication for intercostal neuralgia. Mean hospital stay was 4.06 days. Mitral valve incompetance was present in one patient. In respect to interviews cosmetic satisfaction was achieved in 91.2% of patients and remaining 6.7% was undecided. Two patients complainted of wide scar formation in incision line. Breast asymetry was exsisted in 3 patients. In summary none of the interviewed patients would have prefered sternotomy in operation technique.Conclusion: Right anterior minithoracotomy in closure of atrial septal defects in regards to cosmetic aspects would be prefered especially in female patients with reliable results and high patient satisfaction.

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