Denyan MANSUROĞLU, Altuğ TUNÇER, Mete ALP, Cevat YAKUT, Gökhan İPEK, Hasan Basri ERDOĞAN, Suat Nail ÖMEROĞLU

Surgical treatment of aortic regurgitation accompanying ventricular septal defect and long term results

Amaç: Ventriküler septal defekt ve aort yetersizliği bulunan hastaların cerrahi tedavisinin uzun dönem sonuçları incelendi. Çalışma planı: 1985-2004 yılları arasında ventriküler septal defekt ile birlikte aort yetersizliği bulunan dokuz hastaya (%2.86) (7 erkek, 2 kadın; ort. yaş 21.44±12.9; dağılım 8-45) girişim yapıldı. Hastaların altısında ventriküler septal defekt subaortik yerleşim gösterirken, üçünde perimembranözdü. İki olguda geçirilmiş endokardit öyküsü olduğu saptandı. Ventriküler septal defekt, uygun olan dört olguda transaortik, geri kalan beş olgunun üçünde sağ atriyal, bir olguda sağ ventriküler, bir olguda ise hem sağ atriyal hem de sağ ventriküler kesi ile onarıldı. Hastaların sekizinde ventriküler septal defekt Dacron ile kapatılırken, birinde sağ koroner kusp inverte edilerek yama olarak kullanıldı. Orta dererecede aort yetersizliği olan üç olguya resüspansiyon uygulanarak yetersizlik giderildi. Onarıma uygun olmayan altı hastada kapak replasmanı yapıldı. Bulgular: Çalışmaya alınan hastalar ortalama 62.5±40 (7-120) ay izlendi. Hiçbir hastada erken ve geç mortalite görülmedi ve atriyoventriküler blok gözlenmedi. Aort kapağına onarım uygulanan üç olgunun ameliyat sonrası yapılan ekokardiyografik kontrollerinde anlamlı bir kaçak saptanmadı. Ameliyat sonrası ortalama efor kapasiteleri ameliyat öncesi döneme oranla düzelme gösterdi (p=0.016). Ekokardiyografik ölçümlerde ortalama sol ventrikül sistol sonu çapı ve diyastol sonu çapları ameliyat sonrasında anlamlı derecede düzeldi (p=0.034, p

Ventriküler septal defekt ve aort yetersizliğinde cerrahi tedavi ve uzun dönem sonuçları

Background: We present the long-term results of patients operated for aortic regurgitation accompanying ventricular septal defect (VSD). Methods: Out of 314 patients operated for VSD between 1985-2004, 9 patients (2.86%) (7 males, 2 females; mean age 21.44±12.9 years; range 8 to 45 years) had VSD associated with aortic regurgitation. In six patients VSD was subaortic whereas in three patients it was located in the perimembranous septum. Two patients had history of infective endocarditis. VSD was repaired via transaortic route in four cases. In three of the remaining five patients, the defect was reached and repaired through right atrial incision, in one patient through right ventricular incision and in one patient through both right atrial and right ventricular incisions. In eight patients VSD was repaired with dacron patch and in one patient with native inverted insitu right coronary cusp tissue. In three cases with moderate aortic regurgitation, resuspension was performed to relieve regurgitation. Aortic valve replacement was performed in six patients with aortic valves unsuitable for repair. Results: Mean follow-up of patients was 62.5±40 (7-120) months. There was no early mortality. Atrioventricular block was not observed in any of patients. Significant aortic regurgitation was not detected upon postoperative echocardiographic controls of three patients who underwent aortic valve repair. Postoperative mean functional capacity showed significant improvement in accordance to preoperative values (p=0.016). On echocardiographic measurements, a statistically significant improvement was detected between preoperative and postoperative mean left ventricular endsystolic and end-diastolic diameters (p=0.034,

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1. Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL. Ventricular septal defect. In: Kirklin/Barrat-Boyes, editor. Cardiac surgery. 3rd ed. Philadelphia, PA: Churchill Livingstone; 2003. p. 850-909.
2. Garamella JJ, Cruz AB Jr, Heupel WH, Dahi J, Jensen NK, Berman R. Ventricular septal defect with aortic insufficiencyl Successful surgical correction of both defects by the transaortic approach. Am J Cardiol 1960;5:266-72.
3. Starr A, Menashe V, Dotter C. Surgical correction of aortic insufficiency associated with ventricular septal defect. Surg Gynecol Obstet 1960;lll:71-6.
4. Trusler GA, Moes CA, Kidd BS. Repair of ventricular septal defect with aortic insufficiency. J Thorac Cardiovasc Surg 1973;66:394-403.
5. Spencer FC, Doyle EF, Danilowicz DA, Bahnson HT, Weldon CS. Long-term evaluation of aortic valvuloplasty for aortic insufficiency and ventricular septal defect. J Thorac Cardiovasc Surg 1973;65:15-31.
6. Chauvaud S, Serraf A, Mihaileanu S, Soyer R, Blondeau P, Dubost C, et al. Ventricular septal defect associated with aortic valve incompetence: results of two surgical managements. Ann Thorac Surg 1990;49:875-80.
7. Carpentier A. Cardiac valve surgery—the "French correction". J Thorac Cardiovasc Surg 1983;86:323-37.
8. Yacoub MH, Khan H, Stavri G, Shinebourne E, Radley Smith R. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg 1997;113:253-60.
9. Sim EK, Grignani RT, Wong ML, Quek SC, Wong JC, Yip WC, et al. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg 1999; 67:736-8.
10. Ohkita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Komeda M, et al. Reoperation after aortic valvuloplasty for aortic regurgitatiön associated with ventricular septal defect. Ann Thorac Surg 1986;41:489-91.
11. Kalangos A, Beghetti M, Murith N, Faidutti B. Leaflet's free edge suspension for correction of aortic insufficiency associated with ventricular septal defect. Ann Thorac Surg 1998;65:566-8.
12. Okita Y, Miki S, Kusuhara K, Ueda Y, Tahata T, Yamanaka K, et al. Long-term results of aortic valvuloplasty for aortic regurgitatiön associated with ventricular septal defect. J Thorac Cardiovasc Surg 1988;96:769-74.
13. Boone JW, Vincent RN, Dooley KJ, Williams WH. Ventricular septal defect closure without aortic valve plication in patients with aortic valve prolapse. Am J Cardiol 1990;65:1271-3.
14. Keane JF, Plauth WH Jr, Nadas AS. Ventricular septal defect with aortic regurgitatiön. Circulation 1977;56(1 Suppl):I72-7.
15. Trusler GA, Williams WG, Smallhorn JF, Freedom RM. Late results after repair of aortic insufficiency associated with ventricular septal defect. J Thorac Cardiovasc Surg 1992; 103:276-81.
16. Atay Y, Yağdı T, Başarır Ş, Bakalım T, Buket S, Durmaz İ ve ark. Ventriküler septal defekt ve aort yetersizliğinde cerrahi tedavi. Türk Göğüs Kalp Damar Cer Derg 1997;5:38-43.