Cevat YAKUT, Hasan EKİM, Mustafa TUNCER, Veysel KUTAY

Genç erişkinlerde 19 ve 21 milimetrelik aort kapak protezlerinin hemodinamik performans ve fonksiyonel kapasite üzerine etkileri

Amaç: Aort stenozu nedeniyle 19 mm veya 21 mm ikiyaprakçıklı aortik mekanik protez kapak replasmanı uygulanan genç erişkin hasta grubunda ameliyat sonrası erken ve orta dönem fonksiyonel kapasite artışı ve sol ventrikül hipertrofi gerilemesi değerlendirildi. Çalışma planı: Romatizmal aort stenozu nedeniyle izole aort kapak replasmanı uygulanan 14 hasta (10 erkek, 4 kadın; ort. yaş 25±7; dağılım 17-41) çalışmaya alındı. Olguların altısında 19 mm, sekizinde 21 mm ikiyaprakçıklı mekanik protez kullanıldı. Ortalama vücut yüzey alanı 21 mm protez kullanılan olgularda 1.76 m2, 19 mm protez kullanılan olgularda 1.58 m2, tüm olgularda 1.7±0.15 m2 idi. New York Heart Association (NYHA) fonksiyonel kapasite 10 olguda sınıf II, dört olguda sınıf III idi. İmplantasyon, iki olgu dışında, tüm olgularda aort kökü genişletilmeksizin uygulandı. Tüm olgularda istirahatte ve maksimal egzersiz sonrasında transtorasik ekokardiyografi ile transvalvüler gradiyent, efektif kapak alanı ve sol ventrikül çapları ölçüldü. Ortalama takip süresi 32±11 ay (dağılım 12-56 ay) idi. Bulgular: Olguların hiçbirinde ölüm ve ameliyat sonrası dönemde komplikasyon görülmedi. Fonksiyonel kapasite açısından tüm olgular NYHA sınıf I olarak demnesğerlendirildi (p=0.01). Ameliyat öncesine göre, ameliyat sonrası transvalvüler ortalama gradiyentte (p=0.005) ve sol ventrikül kütle indeksinde (p=0.01) belirgin iyileşme görüldü. Sonuç: Bulgularımız, genç erişkinlerde 19 mm ve 21 mm mekanik protez replasmanının ameliyat sonrası erken ve orta dönemde mortalite ve morbiditeyi artırmadığını; ayrıca, semptomların gerilemesi ve fonksiyonel kapasite artışı açısından belirgin düzelme sağladığını göstermektedir.

The effect of 19- and 21- milimeter aortic valve prostheses on hemodynamic performance and functional capacity in young adults

Background: The aim of this study was to evaluate early and mid-term improvement in functional capacity and left ventricular mass in young adults following implantation of 19-mm or 21-mm bileaflet mechanical aortic prostheses. Methods: Fourteen patients (10 males, 4 females; mean age 25±7 years; range 17 to 41 years) underwent isolated aortic valve replacement due to rheumatic aortic valve stenosis. The size of the bileaflet mechanical prostheses was 19 mm in six patients, and 21 mm in eight patients. The mean body surface area was 1.7±0.15 m2 (1.58 m2 and 1.76 m2 for 19- and 21-mm prostheses, respectively). Functional capacity was New York Heart Association (NYHA) class II in 10 patients, and class III in four patients. Implantation was performed without enlargement of the aortic root in all but two patients. At the end of a mean follow-up of 32±11 months (range 12 to 56 months), transvalvular gradients, effective orifice area, and the diameter of the left ventricle were calculated by transthoracic echocardiography in all the patients during rest and after maximal treadmill exercise. Results: There was no mortality or any postoperative complications. All the patients were in NYHA functional class I at the last follow-up (p=0.01). Compared to preoperative values, significant improvements were observed postoperatively in the mean transvalvular gradient (p=0.005) and left ventricular mass (p=0.01). Conclusion: Our results suggest that implantation of 19-mm or 21-mm aortic bileaflet mechanical prostheses results in significant symptomatic and functional improvement in young adults, without contributing to mortality and complications.

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