Sait AŞLAMACI, Bahadır GÜLTEKİN, Birgül VARAN, Kürşat TOKEL, Süleyman ÖZKAN, Tankut AKAY, Ahmet ASLAN

Fallot tetralojisinde sağ ventrikül çıkım yolu tamir yöntemlerinin sağ ventrikül fonksiyonları üzerine etkisi

Amaç: Fallot tetralojisinde transannuler ya da infundibuler yama kullanılarak yapılan tam düzeltme sonrası uzun dönemde sağ ventrikül fonksiyon bozuklukları değerlendirildi. Çalışma planı: 1983-1996 yılları arasında Fallot tetralojisi nedeniyle ameliyat edilen ve en az beş yıl izlenen 39 hasta (ort. yaş 12.1±3.1; dağılım 8-21) çalışmaya alındı. Sağ ventrikül çıkım yolu tamirinde 26 hastada transannuler yama, 13 hastada infundibuler yama kullanıldı. Tüm hastalar telekardiyografi, ekokardiyografi ve efor testiyle değerlendirildi. Ortalama takip süresi 7.1±2.1 yıl (dağılım 5-13 yıl) idi.Bulgular: Pulmoner kapak yetersizliği transannuler yama kullanılan grupta belirgin olarak fazla bulundu (p=0.037). Tüm hastalarda ortalama rezidüel pulmoner gradiyent 20 mmHg’nin altındaydı ve iki grup arasında fark yoktu (p=0.63). Ameliyat sonrası erken dönemde ventrikül basınçları oranı azaldıkça pulmoner gradiyentin azaldığı görüldü. Transannuler yama kullanılan grupta sağ ventrikül diyastol sonu çap ve hacimleri, atım hacmi ve hacim indeksi daha yüksekti ve sağ ventrikül disfonksiyonunu gösteriyordu (p

The effect of right ventricle outflow tract reconstruction methods on right ventricular function in tetralogy of fallot

Background: We evaluated long-term right ventricular dysfunction following total repair of tetralogy of Fallot (TOF) using a transannular or infundibular patch. Methods: The study included 39 patients (mean age 12.1±3.1 years; range 8 to 21 years) who were operated on between 1983 and 1996, and had a follow-up of at least five years. Reconstruction of the right ventricle outflow tract was performed with a transannular and infundibular patch in 26 and 13 patients, respectively. The patients were assessed by telecardiography, echocardiography, and treadmill exercise. The mean follow-up was 7.1±2.1 years (range 5 to 13 years).Results: Pulmonary valve insufficiency was significantly more common in the transannular patch group (p=0.037). Residual pulmonary gradient was lower than 20 mmHg in all the patients, with no significant difference (p=0.63). In the early postoperative period, it was found that decreases in ventricular pressure ratios were correlated with decreases in the pulmonary gradient. Right ventricle end-diastolic diameters and volumes, stroke volumes, and volume indexes were significantly higher in the transannular patch group, showing dysfunction (p

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