Nilgün BOZBUĞA, Kaan KIRALİ, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, Gökhan İPEK, Hasan Basri ERDOĞAN, Nihan KAYALAR

Reoperations after total correction of tetralogy of fallot

Amaç: Fallot tetralojisi (TOF) için uygulanan radikal düzeltme ameliyatlarının erken dönem sonuçları çok iyi olmakla birlikte, bazı hastalarda ikinci, hatta üçüncü kez ameliyat gerektiği bilinmektedir. Bu çalışmada, ameliyat tekrarı gerektiren endikasyonlar, uygulanan prosedürler ve tekrar ameliyat edilen hastalardaki klinik sonuçlar değerlendirildi. Çalışma planı: Kliniğimizde 1985-2003 tarihleri arasında 211 hastaya TOF tanısı ile radikal düzeltme ameliyatı uygulandı. Bu hastaların 12’sinde (%5.6; 7 kadın, 5 erkek; ort. yaş 14.4±5.6; dağılım 6-25) yeniden ameliyat gerekti. Tüm hastalarda yeniden ameliyat endikasyonu rezidüel ventriküler septal defekt (VSD) idi. Ek olarak, beş hastada ciddi sağ ventrikül çıkım yolu (RVOT) obstrüksiyonu, bir hastada ciddi pulmoner kapak yetersizliği vardı. Rezidüel VSD’yi kapatmak için yedi hastada yeni bir yama kullanıldı; beş hastada ilk ameliyatta konmuş olan yama pledgetli dikişlerle onarıldı. Pulmoner yetmezliği olan hastaya ksenogreft yerleştirildi. Hastaların ikinci ameliyattan sonra ortalama takip süresi 48.4±9 aydı.Bulgular: Ameliyat sırasında ölen hasta olmadı. Bir hastada sternotomi sırasında sağ ventrikül yaralanması dışında komplikasyon gelişmedi. İnfektif endokardite bağlı olarak gelişen tekrarlayan VSD nedeniyle bir hasta üçüncü defa ameliyata alındı. Sekiz hasta NYHA sınıf I, üç hasta sınıf II fonksiyonel kapasitede idi. Hiçbir olguda residüel VSD veya pulmoner yetersizlik saptanmadı. Üçüncü ameliyat uygulanan hasta yoğun serebral kanama nedeniyle kaybedildi.Sonuç: Total düzeltme ameliyatı sonrası rezidüel VSD ve RVOT patolojisi saptanan hastalarda sağ ventrikül yetersizliği ve klinik bozulma saptanırsa, ikinci bir ameliyat planlanmalıdır. Tekrar ameliyat ile rezidüel VSD ve RVOT patolojisi düzeltilen hastaların orta dönem sonuçları tatminkardır.

Fallot tetralojisi onarımı sonrası yeniden ameliyat gerektiren olgular

Background: Although the immediate results of definitive repair for tetralogy of Fallot (TOF) are excellent, it is known that some patients require a second or even third operation. The aim of this study was to analyze the indications, surgical procedures, and clinical outcomes of patients undergoing reoperation. Methods: Between 1985 and 2003, 211 patients underwent corrective repair for TOF in our clinic. Of these, 12 patients (%5.6; 7 females, 5 males; mean age 14.4±5.6 years; range 6 to 25 years) required reoperation. In all the patients, indication for reoperation was residual ventricular septal defect (VSD). Additionally, five patients had severe right ventricular outflow tract (RVOT) obstruction, and one patient had severe pulmonary regurgitation. At the reoperation, a new patch was placed to close the residual VSD in seven patients, and the former patch was repaired with pledgeted sutures in the remaining five. A pulmonary xenograft was implanted in the patient with severe pulmonary valve insufficiency. The mean follow-up after reoperation was 48.4±9 months.Results: There was no operative mortality. The only perioperative complication was injury to the right ventricle during sternotomy in one patient. One patient underwent a third operation for recurrent VSD due to infective endocarditis. Functional status was NYHA class I in eight patients, and class II in three patients. On final evaluations, there was no residual VSD or pulmonary regurgitation. The only mortality occurred due to a massive cerebral hemorrhage in the patient who underwent a third operation.Conclusion: For patients presenting with residual VSD or RVOT problems after correction of TOF, a reoperation should be considered in case progressive right ventricular failure and clinical deterioration develop. Reoperations are effective in relief of residual VSDs and RVOT pathologies and offer good mid-term results.

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