İlker MATARACI, Cemalettin AYDIN, Adil POLAT, Kaan KIRALİ, Çetin Murat SONGUR, Vedat ERENTUĞ, Cevat YAKUT, Mehmet YANARTAŞ

Hipertrofik obstrüktif kardiyomiyopatide cerrahi tedavi ve sonuçları

Amaç: Çalışmamızda hipertrofik obstrüktif kardiyomiyopati (HOKM) tanısıyla kliniğimizde cerrahi tedavi uygulanan hastaların erken ve geç dönem sonuçları incelendi.Çalışma planı: Kliniğimizde Eylül 1985-Eylül 2008 tarihleri arasında HOKM tanısıyla cerrahi girişimde bulunulan 32 hasta (13 erkek, 19 kadın; ort. yaş 35.1±17.6 yıl; dağılım 7-68 yıl) çalışmaya alındı. Göğüs ağrısı, çarpıntı ve nefes darlığı başlıca semptomlar olarak tespit edildi. Tüm hastalara ameliyat öncesi ve sonrası ekokardiyografi, aynı zamanda 27 hastaya ise ameliyat öncesi kardiyak kateterizasyon yapıldı. Tüm hastalara genel anestezi altında septal miyektomi işlemi uygulandı. Ek girişim olarak hastaların ikisinde (%6.3) mitral kapak onarımı, altısında (%18.8) mitral kapak replasmanı, ikisinde (%6.3) aort kapak replasmanı ve birinde (%3.1) aort kapak replasmanı + koroner arter bypass işlemleri uygulandı.Bulgular: Üç hastada (%9.4) ameliyat sonrası dönemde tam kalp bloğu gelişti ve kalıcı pacemaker implantasyonu uygulandı. Ameliyat sonrası bir olgumuz ritim düzensizliği, bir olgumuz da konjestif kalp yetmezliği nedeniyle takip altına alındı. Ameliyat sonrası erken dönemde iki hasta (%6.3) ve geç dönemde de iki hasta (%6.3) olmak üzere toplam dört hasta kaybedildi. Beş yıllık sağkalım oranı yüzde 95.2±2.4 idi.Sonuç: Hipertrofik obstrüktif kardiyomiyopatinin cerrahi tedavisinde ek girişimlerin uygulanması ile mortalite ve morbiditede artış görülmektedir. Buna rağmen septal miyektomi işlemi, farmakolojik tedaviye yanıt alınamayan olgularda düşük morbidite ve mortalite ile gerçekleştirilebilecek bir yöntemdir.

The results of the surgical treatment of hypertrophic cardiomyopathy

Background: We have reviewed the early and long term results of the patients who were operated for hypertrophic obstructive cardiomyopathy (HOCM) in our clinic.Methods: Thirty-two patients with HOCM (13 males, 19 females; mean age 35.1±17.6 years; range 7 to 68 years) who were operated on between September 1985 and September 2008 were included in the study. The main presenting symptoms were chest pain, palpitation and dyspnea. Echocardiography was performed in all patients both preoperatively and postoperatively and 27 had catheterization preoperatively. We performed septal myectomy in all cases under general anesthesia. Concomitantly mitral valve reconstruction in two (6.3%), mitral valve replacement in six (18.8%), aortic valve replacement in two (6.3%) and aortic valve replacement + coronary artery bypass in one (3.1%) were performed.Results: Three patients (9.4%) required permanent pacemaker implantation postoperatively due to complete heart block. In the follow-up one patient has arrhythmia and another one has congestive heart failure. In the postoperative period, early mortality was 6.3% with two cases and the late term mortality was 6.3% with two cases with a total four cases. The five-year survival rate was 95.2%±2.4.Conclusion: Concomitant procedures increase the mortality and morbidity in hypertrophic obstructive cardiomyopathy surgery. However, in patients unresponsive to medical treatment septal myectomy is a procedure which can be performed with low morbidity and mortality.

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