Akın İZGİ, Yayla Eylem AKVARDAR, Atakan ERKILINÇ, Ulusoy Nilgün BOZBUĞA, Kaan KIRALİ, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, Gökhan İPEK

Hipertrofik kardiyomiyopatide cerrahi tedavi

Amaç: Hipertrofik kardiyomiyopati nedeni tam bilinmeyen küçük sol ventrikül kavitesi, artmış sistolik fonksiyon ve bozulmuş olan diyastolik fonksiyonla karakterize primer kalp kası hastalığıdır. Kliniğimizde cerrahi müdahalede bulunulan 10 hipertrofik kardiyomiyopati olgusunu literatür eşliğinde sunmaktayız. Materyal ve Metod: 1985-2002 tarihleri arasında hipertrofik kardiyomiyopati nedeni ile cerrahi girişimde bulunulan 10 olgunun 8'i kadın, 2'si erkek olup yaşlan 5-68 yıl arasında değişiyordu. Çarpıntı ve nefes darlığı başlıca semptomdu. Hastaların hepsine preoperatif ve postoperatif ekokardiyografik inceleme ile 8 olguda preoperatif kateterizasyon yapıldı. Bulgular: Erken ve geç dönem mortalite görülmedi. İki olguda postoperatif dönemde geçici tam kalp bloğu gelişti. Bir olguda postoperatif geç dönemde supraventriküler taşikardi, l olguda da konjestif kalp yetmezliği görüldü. Sonuç: Hipertrofik kardiyomiyopati tedavisinde septal miyektomi girişimi, farmakolojik tedavinin yetersiz kaldığı olgularda düşük mortalite ve morbidite oranları ile yapılan cerrahi girişim şeklidir.

Surgical treatment in hypertrophic obstructive cardiomyopathy

Background: Hypertrophic obstructive cardiomyopathy is a primary cardiac muscular disease with unknown etiology, characterised by small left ventricular cavity, increased systolic function and diastolic dysfunction. We presented here 10 patients with hypertrophic obtructive cardiomyopathy, who were operated on in our clinics, with literature review. Methods: Between 1985 and 2002, ten patients were operated on due to hypertrophic obstructive cardiomyopathy in our clinics. Eight patients aged between 5 and 68 years were female and 2 were male. Palpitation and dyspnea were the primary symptoms. All patients underwent pre and postoperative echocardiographic examination and cardiac catheterisation was performed in 8 patients. Results: There was no early and late postoperative mortality. In two patients temporary complete AV-blok was observed during early postoperative period. During long-term follow-up supraventricular tachycardia was observed and one patient was presented with congestive heart failure. Conclusion: Septal myectomy is the surgical treatment of choice performed with low mortality and morbidity rates in patients with hypertrophic obtructive cardiomyopathy for whom the pharmacological treatment modalities are insufficient.

PDF

___

1) Maron BJ. Hypertrophic cardiomyopathy. Lancet 1997;350:127-33.
2) Maron BJ, Mathenge R, Casey SA, et al. Clinical profile of hypertrophic cardiomyopathy identified de novo in rural communities. J Am Coll Cardiol 1999;33:1590-5.
3) Rakowski H, Sasson Z, Wigle ED. Echocardiographic and Doppler assesment of hypertrophic cardiomyopathy. J Am Soc Echocardiography 1998;1:31-47.
4) Dilsizian V, Bonow RO, Epstein SE, Fananapazir L. Myocardial ischemia detected by thallium scintigraphy is frequently related to cardiac arrest and syncope in young patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 1993;22:796-804.
5) Birinçioğlu CL. Hipertrofik Kardiyomyopati. T Klin Kardiyol 2003;16:14-34.
6) Spirito P, Seidman CE, McKenna WJ, Maron BJ. Management of hypertrophic cardiomyopathy. N Eng J Med 1997;336:775-85.
7) Schulte HD, Borisov K, Gams E, Gramsch-Zabel H, Losse B, Scwarrtzkopff B. Management of symptomatic hypertrophic obsturictive cardiomyopathy: Long-term results after surgical therapy. Thorac Cardiovasc Surg 1999;47:213-8.
8) Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy: Echocardiography, pathophysiology, and the continuing evolution of surgery for obsturiction. Ann Thorac Surg 2003;75:620-32.
9) McIntosh CL, Greenburg GH, Maron BJ, et al. Clinical and hemodynamic results after mitral valve replacement in patients with obstructive hypertrophic cardiomyopathy. Ann Thorac Surg 1989 47:236-46.
10) Maron BJ, Nishimura RA, McKenna WJ, et al. Assesment of permanent dual chamber pacing as a treatment for drug refractory symptomatic patients with obstructive hypertrophic cardiomyopathy: A randomized, double blind, cross over study (M-PATHY). Circulation 1999;99:2927-33.
11) Maron BJ, Shen W-K, Link MS, et al. Efficiancy of implantable cardioverter - defibrillators for preventions of sudden death in patients with hypertrophic cardiopathy. N Eng J Med 2000;342:365-73.
12) Seggewiss H, Faber L, Gleichmann U. Percutaneus transluminal septal ablation for hypertrophic obstructive cardiomyopathy. Thorac Cardiovasc Surg 1999;47:94-100.