Sinan ARSAN, Tekin YILDIRIM, Ali CİVELEK, Selim İSBİR, Serdar AKGÜN, Atike TEKELİ, Mine ÖZ, Nazan AKSOY

Ciddi pulmoner hipertansiyonu olan hastalarda mitral kapak cerrahisi sonuçlarımız

Amaç: Ciddi pulmoner hipertansiyon, mitral kapak replasmanı ve sonrasındaki önemli morbidite ve mortalite faktörlerinden birisidir. Çalışmamızda son iki yılda ameliyat ettiğimiz, ciddi pulmoner hipertansiyonlu mitral kapak hastalarının erken dönem sonuçlarını vermekteyiz. Materyal ve Metod: Ocak 2001 - Kasım 2002 tarihleri arasında ciddi pulmoner hipertansiyonlu 63 hastaya mitral kapak cerrahisi uygulandı. Hastaların 38'i (%60.3) kadın, 25'i (%39.7) erkek olup, ortalama yaşı 49.5 ± 10.5 (24-68) idi. Preoperatif dönemde 38 hasta (%60.3) New York Heart Association (NYHA) fonksiyonel sınıf IV, 15 hasta (%23.8) NYHA III ve 10 hasta (%15.8) ise NYHA II efor kapasitesinde idi. Tüm hastalar preoperatif olarak iki boyutlu transtorasik ve Doppler ekokardiyografi ile değerlendirildi. Otuz hastaya (%47.6) mitral kapak replasmanı (MVR) uygulanırken, 15 hastaya (%24) kombine MVR ve aortik kapak replasmanı, 18 hastaya (%28.5) ise MVR ve triküspid kapağa de Vega annuloplasti uygulandı. Bulgular: Erken mortalite %7.93 (5 hasta), geç mortalite %1.7 (1 hasta) idi. Hastaların postoperatif fonksiyonel kapasitelerinde belirgin bir artış gözlendi: 20 hasta (%35) NYHA I, 31 hasta (%55) NYHA II, 6 hasta (%10) ise NYHA III efor kapasitesinde idi (p < 0.05). Sistolik pulmoner arter basıncı ortalama 83.06 ± 12.9 mmHg'dan, 39.6 ± 14 mmHg'ya düştü (p < 0.001). Sonuç: Ciddi derecede pulmoner hipertansiyonu olan kapak hastaları cerrahi tedaviden fayda görmektedirler ve cerrahi tedavi bu hastalarda güvenle uygulanabilir.

The results of mitral valve surgery in patients with severe pulmonary hypertension

Background: Severe pulmonary hypertension is still one of the main causes of morbidity and mortality in mitral valve surgery. Here, we presented the early results of mitral valve surgery in patients with severe pulmonary hypertension. Methods: Sixty-three patients with severe pulmonary hypertension underwent mitral valve surgery between January 2001 and November 2002. Thirty-eight (%60.3) patients were female, 25 (%39.7) patients were male, the mean age of the patients was 49.5 ± 10.5 (ranged 24 to 68 years). Preoperatively 38 (%60.3) patients were in New York Heart Association (NYHA) functional class IV, 15 (%23.8) patients in NYHA class III and 10 (%15.8) patients were in NYHA class II. Preoperative echocardiographic assessments were performed in all patients. Thirty (%47.6) patients underwent isolated mitral valve replacement (MVR), 15 (%24) patients underwent both MVR and aortic valve replacement, and 18 (%28.5) patients underwent MVR and tricuspid valve de Vega annuloplasty. Results: The early mortality rate was 7.93% (n = 5), and late mortality rate was 1.7% (n = 1). The functional capacity of the patients improved significantly: 20 (%35) patients were in NYHA class I, 31 (%55) patients in NHYA class II, and 6 (%10) patients in NYHA class III postoperatively (p < 0.05). Systolic pulmonary artery pressure dropped from 83.06 ± 12.9 mmHg to 39.6 ± 14 mmHg (p < 0.001). Conclusions: Patients with mitral valve disease benefit from surgical treatment regardless of the degree of pulmonary hypertension. Pulmonary hypertension decreases significantly after operation.

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