Evren ÖZÇINAR, Ali İhsan HASDE, Rüçhan AKAR, Mustafa Bahadır İNAN, Mustafa SIRLAK, Levent YAZICIOĞLU

İnfarktüs sonrası ventriküler septal rüptürün cerrahi tedavisi

Amaç: Bu çalışmada son on yıllık dönemde miyokard infarktüsü sonrası ventriküler septal rüptür (VSR) nedeni ile kliniğimize başvuran 21 hastanın sonuçları bildirildi. Çalışma planı: Kliniğimize on yıllık dönem içinde infarktüs sonrası VSR nedeniyle başvuran 21 hasta (14 erkek, 7 kadın; ort. yaş 59.6±8.8 yıl; dağılım 52-73 yıl) geriye dönük olarak incelendi. Bu hastaların hepsi anjina pektoris (AP) yakınması ile başvuran ve koroner arter hastalığı ve VSR tanısı konulan hastalardı. Klinik olarak stabil olmayan hastalar intra-aortik balon pompası (İABP) destekli veya desteksiz medikal tedavi ile stabilize edildikten sonra ameliyata alındı. Mortalite ve morbiditeye ek olarak ameliyat öncesi, sırası ve sonrası veriler geriye dönük olarak kaydedildi. Taburcu sonrası hastalar üç aylık aralıklarla takip edildi.Bulgular: Ventriküler septal rüptür 16 hastada anteriyorda, beş hastada ise posteriyorda idi. Dokuz hasta acil koşullarda ameliyat edilirken diğer 12 hasta hemodinamik olarak stabilizasyonu takiben ameliyat edildi. Hastaların %81'inde ameliyat öncesi İABP desteğine, %65'inde ise inotrop desteğine gereksinim duyuldu. Bütün hastalara kardiyopulmoner bypass (KPB) eşliğinde koroner arter bypass greftleme ve yama ile VSR onarımı yapıldı. Ameliyat sırası mortalite iki hastada görüldü. Ortalama kross klemp zamanı 87.1±11.3 dakika, KPB zamanı ise 138.6±19.9 dakikaydı. Kardiyopulmoner bypasstan ayrılırken hastaların %100'ünde İABP desteğine, %94'ünde inotrop desteğine, %29'unda ise geçici pacemaker desteğine gereksinim duyuldu. Yoğun bakım ünitesinde ortalama kalış süresi 6.2±4.4 gün, ortalama hastanede kalış süresi ise 13.0±5.6 gündü. Ameliyat sonrası beş hasta, taburculuk sonrası takipte ise iki hasta kaybedildi. Hastaların taburcu sonrası ortalama takip süresi 46.6±18.1 ay idi.Sonuç: Miyokard infartüsü sonucu meydana gelen VSR günümüzde halen mortalitesi yüksek bir patolojidir. Ameliyat öncesinde farmakolojik destek ve İABP desteğinin mortalite ve morbiditenin azaltılmasında çok önemli bir rol oynar.

Surgical treatment of postinfarction ventricular septal rupture

Background: In this study, we reported the results of 21 patients who were admitted to our clinic with ventricular septal rupture (VSR) that developed after myocardial infarction. Methods: Twenty-one patients (14 males, 7 females; mean age 59.6±8.8 years; range 52 to 73 years) who were admitted to our clinic with postinfarction VSR were retrospectively evaluated. All of these patients had complaints of angina pectoris and were diagnosed with coronary artery disease and VSR. Clinically unstable patients were operated on following stabilization with medical treatment with/or intraaortic balloon pump (IABP) support. In addition to mortality and morbidity, pre-, intra- and postoperative data were retrospectively recorded. After discharge patients were followed up in every three-month intervals.Results: Ventricular septal rupture was located anteriorly in 16 patients, and posteriorly in five patients. While nine patients underwent emergency surgery, the remaining 12 patients were operated on following establishment of hemodynamic stability. Eighty-one percent of the patients required IABP support before the operation, whereas 65% of them required inotropic support. Coronary artery bypass grafting and VSR patch repair with cardiopulmonary bypass (CPB) were performed on all patients. Perioperative mortality was seen in two patients. The mean cross-clamp time was 87.1±11.3 minutes and the mean CPB time was 138.6±19.9 minutes. During weaning off CPB, 100% of the patients required IABP support, 94% of the patients required inotropic support, and 29% of the patients required temporary pacemaker support. The mean intensive care unit duration was 6.2±4.4 days and the mean hospital duration was 13.0±5.6 days. Postoperative mortality was five patients, and mortality after discharge was two patients. Mean follow-up after discharge was 46.6±18.1 months.Conclusion: Nowadays, VSR caused by myocardial infarction is still a pathology with high mortality. Preoperative pharmacological and IABP support has beneficial effects on decreasing mortality and morbidity.

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