Bülent SARITAŞ, Murat ÖZKAN, Canan AYABAKAN, Emre ÖZKER, Özlam SARISOY

Sağ ventrikül çıkım yolu rekonstrüksiyonu yapılmış olan hastalarda erken dönem pulmoner kapak replasmanı cerrahi sonuçları

Amaç: Bu çalışmada sağ ventrikül çıkım yolu rekonstrüksiyonu yapılan hastalarda erken dönem pulmoner kapak replasmanı cerrahi sonuçlarımız sunuldu. Çalışma planı: Ocak 2009 - Eylül 2016 tarihleri arasında sağ ventrikül çıkım yolu rekonstrüksiyonu sonrasında pulmoner yetmezlik nedeniyle 76 hastaya (34 erkek, 42 kadın; ort. yaş 11.4±5.8 yıl; dağılım 7-18 yıl) pulmoner kapak replasmanı yapıldı. Kronik pulmoner yetmezlikli 54 semptomatik hastada cerrahi endikasyon semptomların sağ ventrikül volüm yüklenmesi ile ilişkili egzersiz intoleransı veya aritmi veya pulmoner arter dallarında darlık ile birlikte veya tek başına fonksiyon bozukluğu gibi semptomlar idi. Asemptomatik 22 hastada cerrahi endikasyon, manyetik rezonans görüntülemeye göre belirlendi. Bulgular: Ortalama takip süresi 60±19 (dağılım 17-108) ay idi. Erken ve geç dönem mortalite gözlenmedi. Ameliyat sonrası dönemde semptomatik hastalarda ortalama sağ ventrikül ejeksiyon fraksiyonu değerinde artış gözlendi; ancak bu istatistiksel olarak anlamlı değildi. Sağ ventrikül alan indeksi, sağ ventrikül hacim indeksi ve triküspid annulus ölçümlerinde ameliyat öncesi değerlere kıyasla azalma tespit edildi. Semptomatik hastalara kıyasla, sağ ventrikül ejeksiyon fraksiyonundaki artış ve sağ ventrikül alan indeksi, sağ ventrikül hacim indeksi ve triküspid annulus değerlerindeki düşüş asemptomatik hastalarda daha az belirgin olmakla birlikte, istatistiksel olarak anlamlı bir fark görülmedi. Sonuç: Pulmoner kapak replasmanı düşük mortalite ve morbidite oranları ile yapılabilmektedir. Sağ ventrikül fonksiyonunu iyileştirmek için, ameliyat sağ ventrikül hacminde ve fonksiyonlarında geriye dönüşü olmayan değişiklikler başlamadan önce yapılmalıdır.

Early surgical outcome of pulmonary valve replacement in patients with previous right ventricle outflow tract reconstruction

Background: In this study, we present our early surgical outcomes of pulmonary valve replacement in patients who underwent right ventricle outflow tract reconstruction.Methods: Seventy- six patients (34 males, 42 females; mean age 11.4±5.8 years; range 7 to 18 years) underwent pulmonary valve replacement for pulmonary insufficiency following right ventricle outflow tract reconstruction between January 2009 and September 2016. Surgical indications were symptoms including exercise intolerance or arrhythmias which are attributed to the right ventricular volume overload or dysfunction with or without branch pulmonary artery stenosis in 54 symptomatic patients with chronic pulmonary insufficiency. Surgical indication was made according to magnetic resonance imaging in 22 asymptomatic patients.Results: The mean follow- up was 60±19 (range 17 to 108) months. There was no early and late mortality. The mean right ventricular ejection fraction value in symptomatic patients increased in the postoperative period, although it did not reach statistical significance. There was a decline in the right ventricular area index, right ventricular volume index, and tricuspid annulus measurements, compared to preoperative values. Compared to the symptomatic patients, the increase in the right ventricular ejection fraction and the decline in the right ventricular area index, right ventricular volume index, and tricuspid annulus was less prominent in asymptomatic patients, indicating no statistically significant difference.Conclusion: Pulmonary valve replacement can be performed with low morbidity and mortality rates. To relief the right ventricle function, the operation should be performed before the irreversible changes in the right ventricular volumes and functions occur.

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