Mustafa GÜDEN, Kamran KAZIMOĞLU, Murat ARPAZ, Belhhan AKPINAR, Ertan SAĞBAŞ, İlhan SANİSOĞLU

Modifiye dikiş tekniği ile endoventriküler sirküler "Patch Plasty"

Amaç: Çalışmamızın amacı Dor tarafından önerilen endoventriküler sirküler "patch plasty" (EVCPP) tekniğinin daha kolay ve daha hemostatik bir dikiş tekniği ile yapılabilirliğini göstermektir. Materyal ve Metod: Çalışmamıza sol ventrikül anevrizması nedeniyle ameliyat ettiğimiz 12 hastayı dahil ettik. Biz Dacron yamanın sol ventriküle fiksasyonunda "çift devamlı dikiş tekniği" adını verdiğimiz tekniği kullandık. Önce 2/0 prolenle "sınır"a paralel ve yamanın kenarlarından 2-3 mm serbest bırakacak şekilde "devamlı horizontal matriks", sonra 3/0 prolenle ilk dikişe dikey olarak yamanın serbest kenarından ve ventrikülden geçerek "over and over" yöntemi ile sütüre edildi. Bulgular: Postoperatif dönemde fonksiyonel statuslarına göre 8 hasta (%72.7) NYHA 1, 3 hasta (%27.3) NYHA 2 idi. Postoperatif ortalama EF değeri 0.38 ± 0.09 idi. Postoperatif EF artma oranı 0.44 ± 0.29 olarak hesaplandı. Bir hasta erken dönemde respiratuar problem nedeniyle kaybedildi (erken mortalite %8.3). Sonuç: Biz, önerdiğimiz "çift devamlı dikiş tekniği" ile EVCPP-nin daha kolay, daha hemostatik ve daha güvenli uygulandığı düşüncesindeyiz.

Endoventricular circular patch plasty with modified suture technique

Background: The aim of this our study is to indicate that the endoventricular circular patch plasty (EVCPP) which is recommended by Dor can be performed with a simpler and more hemostatic suture technique. Methods: Our study group consists of 12 patients which were operated on with the diagnossis of left ventricular aneurysm. We performed the Dacron patch fixation to the left ventricle with the technique that we name "double continous suture technique". Continous horizontal matrix technique is applied during the first suture, using 2/0 prolene, parallel to the patch border leaving a 2-3 mm free edge. Afterwards, vertical to the first suture line 3/0 prolene is used for the second suture from the free edge of the patch and ventricle with over and over technique. Results: According to their functional status 8 patients were NYHA Class 1 (72.7%) and 3 patients were NYHA Class 2 (27.3%). Postoperative mean EF value was 0.38 ± 0.09. Postoperative increase in EF was measured as 0.44 ± 0.29. There is only one early mortality due to respiratory problems (8.3%). Conclusions: We advocate that EVCPP can be performed more safely, more easily and in a more hemostatic with double continous suture technique we recommend.

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