Postinfarkt ventriküler septal rüptürün cerrahi tedavisinin kısa dönem sonuçları

Amaç: Postinfarkt ventriküler septal rüptürün (PVSR) cerrahi tedavisi için farklı yaklaşımlar vardır. Biz bu hastaları en kısa zamanda ameliyata alarak rüptür yerine ve infarkt dokusunun büyüklüğüne göre cerrahi tekniği ameliyat sırasında belirliyoruz. Bu retrospektif çalışmada postinfarkt ventriküler septal rüptürün cerrahi tedavisindeki bu yaklaşımımızın erken dönem sonuçlarını araştırdık.Çalışma planı: Şubat 2001 ile Nisan 2005 tarihleri arasında yedi hastaya (4 erkek, 3 kadın; ort. yaş 60; dağılım 41-70) postinfarkt ventriküler septal rüptür onarımı yapıldı. Miyokard infarktüsü ve cerrahi tedavi arasında geçen zaman altı olguda ortalama 7.2±2.4 gündü. Bir hasta miyokard infarktüsünden sekiz ay sonra ameliyat edildi. Septal rüptürler anterior (n=2), posterior (n=1), apikal (n=2) ve midseptal (n=2) lokalizasyondaydı. Onarım tekniği olarak iki hastada plikasyon, bir hastada infarkt eksizyon tekniği, iki hastada modifiye bir infakt dışlama tekniği ve iki hastada da apikal amputasyon ve teflon felt destekli interrupted sütürlerle kapama tekniği kullanıldı. Üç hastada koroner bypass yapıldı.Bulgular: Bütün hastalar inotropik destekle yoğun bakım ünitesine alındı. Dört hastada intra aortik balon pompası kullanıldı. Bir hasta (%14.3) kaybedildi. Yaşayan hastaların ortalama yoğun bakım kalış süresi 4.6 (2-9) gün, hastanede kalış süresi 11.4 (6-29) gündü. Hiçbir hastada rezidüel şant görülmedi.Sonuç: Postinfarkt ventriküler septal rüptürün onarımında her hastada aynı tekniği kullanmaktansa, tekniğin hastaya göre seçilmesi ile gerek mortalite gerekse rezidü şant oranları bakımından daha başarılı sonuçlar elde edilebilir.

Short term results of surgical treatment of postinfarction ventricular septal rupture

Background: There are different approaches for surgical treatment of postinfarction ventricular septal rupture (PVSR). We prefer to take our patients to the operation immediately and choose the most appropriate operative technique during the operation according to the extent of infarction and the site of rupture. In this retrospective study we sought short-term results of our approach in surgical treatment of PVSR.Methods: Seven patients (4 males, 3 females; mean age 60 years; range 41 to 70 years) underwent repair of PVSR in our clinic between February 2001 and April 2005. Mean time interval between myocardial infarction and surgical treatment was 7.2±2.4 days in six cases. One patient was operated eight months after myocardial infarction. Locations of septal ruptures were anterior (n=2), posterior (n=1), apical (n=2) and midseptal (n=2). The following surgical repair techniques were performed: plication in two patients, infarction excision technique in one patient, a modified infarct exclusion technique in two patients and apical amputation and closure with teflon pledgeted interrupted sutures in two patients. Concomitant coronary artery bypass grafting was performed in three patients.Results: All the patients were transferred to the intensive care unit with inotropic support and intraaortic balloon pump was used in 4 cases. One patient (14.3%) died. Mean intensive care unit stay was 4.6 (2-9) days. Mean duration of hospital stay was 11.4 (6-29) days. There was no residual shunt.Conclusions: For the repair of PVSR, successfull results can be gained, with respect to mortality and residual shunt, by performing surgical intervention during acute phase with choice of a patient-based surgical technique.

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