Mehmet BALKANAY, Denyan MANSUROĞLU, Kaan KIRALİ, Ebat AKINCI, Mete ALP, Vedat ERENTUĞ, Cevat YAKUT, Gökhan İPEK, Mustafa GÜLER, Hasan Basri ERDOĞAN

Ventriküler septal defekt onarımının geç dönem sonuçları ve risk analizi

Amaç: İzole ventriküler septal defekt nedeniyle ameliyat ettiğimiz olguları, cerrahi yaklaşım şekli, postoperatif dönemde karşılaşılan komplikasyonlar ile geç dönem sonuçlarını incelemeyi amaçladık. Materyal ve Metod: Kliniğimizde 1985-2003 yılları arasında izole ventriküler septal defekt tanısıyla ameliyat edildi. Olguların 146 tanesi (%51.2) erkek, 139 tanesi (%48.8) kadındı. Ventriküler septal defekt 218 olguda (%76.4) perimembranöz, 43 olguda (%15) infundibuler, 13 olguda (%4.5) musküler ve 11 olguda (%3.8) inlet tipte idi. Musküler tipteki iki olguda defekt birden fazlaydı. Operasyonda 54 hastada (%18.9) primer kapatma, 217 hastada (%76.1) sentetik yama ve 14 hastada (%4.9) perikardiyal yamayla kapatma uygulandı.Bulgular: Perioperatif mortalite bir olgu ile %0.4 olarak bulundu. Geç dönemde ise üç olgu (%1.2) kardiyak olmayan nedenlerle kaybedildi. Yirmi-iki olguda (%7.7) postoperatif dönemde atriyoventriküler blok tespit edilmiş olup, bunlardan sadece üç tanesine kalıcı kalp pili takılması gerekli oldu. Primer sütür ile kapatılan olguların takiplerinde rezidüel veya rekürren şant saptanmadı. Son 6 yıl içerisinde bütün olgularda sağ atriyotomi sonrası transatriyal yolla cerrahi girişim tamamlandı. Sağ ventrikülotomi ile ventriküler septal defekte ulaşma, geç morbidite açısından istatiksel olarak anlamlıydı.Sonuç: Ventriküler septal defektlerin cerrahi yolla kapatılması ek anomali varlığında bile artan cerrahi deneyim ile düşük morbidite ve mortalite ile gerçekleştirilmektedir. Ventrikülotomi yapmadan ve uygun olgularda primer sütür ile onarım yapmak, erken ve geç komplikasyonları azaltacaktır.

The long term results and risk analysis of the surgical repair of ventricular septal defect

Background: We present postoperative late complications, late follow-up results and surgical intervention techniques who underwent ventricular saptal defect repair. Methods: Between 1985 and 2003, 285 patients with a mean age of 12.6 ± 9 years underwent isolated ventricular septal defect repair in our clinic. There were 146 (51.2%) male and 139 (48.8%) female patients. The type of ventricular septal defect were perimebranous in 218 (76.4%), infundibular in 43 (15%), muscular in 13 (4.3%) and inlet in 11 (3.8%) patients. In two cases the defects were multiple. Fifty four (18.9%) ventricular septal defects were repaired by primary closure and 231 (81.1%) defects were repaired by patch closure. The patch was sythetic in 217 (76.1%) patients and patients own pericardium in 14 (4.9%) patients.Results: There was only 1 (0.4%) hospital mortality. There were 3 (1.2%) late deaths with non cardiac events. Twenty two patients (7.7%) had complete atrioventricular bloc, three of them received a permanent pacemaker. The patients who repaired by primary closure had no residual or recurrent shunts in the late period. In the last six years, all the interventions were made by trans-septal approch from the right atrium. Late morbidity of the approaches that were done by right ventriculotomy were statistically significant (p

PDF

___

1. Grabitz RG, Joffers MR, Collins-Nakai RL. Congenital heart disease: Incidence in the first year of life. The Alberta heritage pediatric cardiology program. Am J Epidemiol 1988;128:381-8.
2. Rizzoli G, Blorkstone EH, Kirklin JW, Pacifico AD Bargeron LM. Incremental risk factors in hospital mortality rate after repair of ventricular septal defect. J Thorac Cardiovasc Surg 1980;80:494-505.
3. Serraf A, Lacour-Gayet F, Bruniaux J, et al. Surgical management of isolated multipl ventricular septal defects. Logical approaach in 130 cases. J Thorac Cardiovasc Surg 1992; 103:437-43.
4. Erdil N, Birincioğlu CL, İşcan HZ ve ark. İzole ventriküler septal defekt cerrahi tedavisinde erken ve geç dönem sonuçlar. T Klin J Cardiol 2000; 13:83-90.
5. Mercan AŞ, Saygılı A, Sezgin A, Kürşad TA, Varan B, Aşlamacı S. infant ventriküler septal defekt cerrahisinde risk faktörleri. Türk Göğüs Kalp Damar Cer Derg 2001;9:149-52.
6. Gaynor JW, O Brien JE, Rychik J, et al. Outcome following tricuspid valve detachment for ventricular septal defect closure. Eur J Cardio-thorac Surg 2001; 19:279-82
7. Tatebe S, Miyamura H, Watanabe H, Suqawara M, Equchi S. Closure of isolated ventricular septal defect with detachment of the tricuspid valve. J Card Surg 1995; 10:564-8.
8. Pridjian AK, Pearce FB, Culpepper WS, et al. Atrioventricular valve competence after take-down to improve exposure during ventricular septal defect repair. J Thorac Cardiovasc Surg 1993;106:1122-5.
9. Sim EKW, Grignani RT, Wong ML, et al. Outcome of surgical closure of doubly committed subarterial ventricular septal defect. Ann Thorac Surg 1999;67:736-8.
10. Okita Y, Miki S, Kusuhara K, et al. Long-term results of aortic valvuloplasty for aortic regurgitation associated with ventriculer septal defect. J Thorac Cardiovasc Surg 1988;96:769-74.
11. Boone JW, Vincent RN, Dooley KJ, Williams WH. Ventriculer septal defect closure without aortic valve plication in patients with aortic valve prolapse. J Am Cardiol 1990; 1271-3.
12. Keane J, Plauth W, Nadas A. Ventriculer septal defect with aortic regurgitation. Circulation 1997;56:172-7.
13. Atay Y, Yağdı T, Başarır Ş ve ark. Ventriküler septal defekt ve aort yetersizliğinde cerrahi tedavi. Türk Göğüs Kalp Damar Cer Derg 1997;5:38-43.
14. Merrick AF, Lal M, Anderson RH, Shore DF. Management of ventricular septal defect. A survey of practice in the United Kingdom. Ann Thorac Surg 1999;68:983-8.
15. Walther T, Tsang VT, Deanfield JE, Deleval MR. Closure of recurrent VSD due to dehiscence of calcified patch. Eur J Cardio-thorac Surg 2003;23:246-7.
16. Demirağ MK, Keçeligil HT, Bahçıvan M, Baysal FK. Primer ventriküler septal defekt ve cerrahi onarımı. T Klin Kalp Dam Cer 2002;3:7-14.