Haşim ÜSTÜNSOY, Mehmet KERVANCIOĞLU, Gökhan GÖKASLAN, Özerdem ÖZÇALIŞKAN, Hayati DENİZ, Yavuz ARSLANOĞLU, Cem ATİK, Senem KORUK

Fallot tetralojisinde tam düzeltme cerrahisinin orta dönem sonuçları

Amaç: Çalışmamızda Fallot tetralojisi (TOF) olan hastalara uygulanan tam düzeltme ameliyatının orta dönem sonuçları sunuldu. Çalışma planı : Ocak 2006 - Ağustos 2011 tarihleri arasında toplam 104 TOF hastasına (60 erkek, 44 kadın; ort. yaş 4.1 yıl; dağıtım 1-24 yıl) tam düzeltme uygulandı. Sağ ventrikül çıkım yolu genişletilmesi 89 hastada transanüler yama ile (10 hastada V-Plasti tekniği ile), 12 hastada sadece sağ atriyotomiden kas rezeksiyonu ile üç hastada ise Contegra greft ile yapıldı. Hastalar pulmoner yetmezlik, transpulmoner gradyan, ventrikül fonksiyonları ve rezidüel ventriküler septal defekt (VSD) varlığını tespit etmek amacıyla ekokardiyografi ile takip edildi. Ortalama takip süresi 26.4 ay (dağılım, 6-62 ay) idi. Bulgular: Yedi hastada erken dönem mortalite izlenirken, geç dönem mortalite gözlenmedi. Olguların ikisine tam atriyoventriküler (AV) blok, birine Mobitz tip-2 AV blok nedeni ile kalıcı pacemaker implante edildi. Kontrol ekokardiyografilerde rezidüel VSD görülmedi. On üç hasta hafif pulmoner yetmezlik ile takip edilmekte iken, takip sırasında ileri pulmoner yetmezlik saptanan yedi olguya pompasız injektabl pulmoner kapak replasmanı uygulandı. Sonuç : Ameliyat sonrası dönemde pulmoner yetmezliği gelişen hastalarda pompasız injektable pulmoner kapak replasmanı göz önünde bulundurulmalıdır.

Midterm results of total correction surgery in tetralogy of Fallot

Background: We aimed to present midterm results of total correction surgery in patients with tetralogy of Fallot (TOF). Methods: A total of 104 patients with TOF (60 males, 44 females; mean age 4.1 years; range 1 to 24 years) underwent total correction between January 2006 and August 2011. Right ventricular outflow tract reconstruction was performed by transannular patching in 89 (V-Plasty technique in 10), by muscular resection from only right atriotomy in 12, and by Contegra graft in three patients. Patients were followed- up by echocardiography to detect the presence of pulmonary insufficiency, transpulmonary gradient, ventricle functions, and residual ventricular septal defect (VSD). The mean follow-up was 26.4 months (range, 6-62). Results: Early-term mortality was seen in seven patients, while no late-term mortality was observed. A permanent pacemaker was implanted to two patients with complete atrioventricular (AV) block and one patient with Mobitz type-2 AV block. Repeated echocardiography showed no residual VSD. Of 13 patients with mild pulmonary insufficiency, seven with severe pulmonary insufficiency during the follow-up period underwent off-pump injectable pulmonary valve replacement. Conclusion: Off-pump injectable pulmonary valve replacement should be considered in patients with postoperative pulmonary insufficiency.

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