Mehmet BALKANAY, Nilgün BOZBUĞA, Adil POLAT, Kaan KIRALİ, Mete ALP, Vedat ERENTUĞ, Esat AKINCI, Cevat YAKUT, Gökhan İPEK, Nihan KAYALAR

Yaşlılarda sekundum atrial septal defektin cerrahi tedavi sonuçları

Amaç: Atriyal septal defekt (ASD), erişkinlerde en sık görülen doğuştan kardiyak anomalidir. Bu çalışmada, ASD nedeniyle ameliyat edilen 60 yaş veya üzerindeki olguların uzun dönem sonuçları geriye dönük olarak incelendi. Çalışma planı: Çalışmaya ASD'li 36 hasta (26 kadın, 10 erkek; ort. yaş 64.9±3.8; dağılım 60-80) alındı. İki hasta (%5.6) ameliyat öncesinde asemptomatikti. Hastalarda en sık rastlanan yakınma dispne idi. Fonksiyonel kapasite dört hastada (%11.1) New York Heart Association (NYHA) sınıf I, yedi hastada (%19.4) sınıf II, 25 hastada (%69.4) sınıf III olarak değerlendirildi. Altı hastada (%16.7) konjestif kalp yetersizliği; 10 hastada (%27.8) atriyal fibrilasyon veya flatter; 19 hastada (%52.8) triküspid kapak regürjitasyonu vardı. Tüm hastalarda pulmoner hipertansiyon (ortalama 50.5±9.9 mmHg, dağılım 35-76 mmHg) saptandı. Ortalama pulmoner/sistemik akım oranı 2.6±0.8 idi (dağılım 1.7-5), ortalama kardiyotorasik oran 0.6±0.1 (dağılım 0.5-0.7) idi. Defektlerin çoğu (%72.2) primer dikişle onarıldı. Beraberinde kardiyak lezyon görülen sekiz olguda onarım ve aortokoroner bypass uygulandı. Ameliyat sırasında ve sonrasında altışar hastada hemodinamik stabilite için intrapulmoner nitrogliserin, prostasiklin ve inotropik destek gerekti. Ortalama izlem süresi 8.2±4.4 yıldı (dağılım 1 ay-16.9 yıl). Bulgular: On iki hastada (%33.3) ölümcül olmayan komplikasyon görüldü. Otuz üç hastada (%91.7) izlem süresi boyunca önemli kardiyovasküler olay gelişmedi. Otuz hastanın (%83.3) fonksiyonel kapasitesinde düzelme görüldü; medyan NYHA sınıf III'ten sınıf I'e geriledi (p

The results of surgical treatment for secundum atrial septal defects in elderly

Background: Atrial septal defect (ASD) is the most common congenital cardiac anomaly in adults. We evaluated the longterm results of surgical correction of ASDs in patients ?60 years of age. Methods: Thirty-six patients (26 women, 10 men; mean age 64.9±3.8 years; range 60 to 80 years) underwent surgery for ASD. Two patients were asymptomatic before surgery. The most common complaint was dyspnea. According to the New York Heart Association (NYHA) functional classification, four patients (11.1%) were class I, seven patients (19.4%) were class II, and 25 patients (69.4%) were class III. Six patients (16.7%) had congestive heart failure, 10 patients had atrial fibrillation or flutter, and 19 patients (52.8%) had tricuspid valve regurgitation. All the patients had pulmonary hypertension (mean 50.5±9.9 mmHg, range 35 to 76 mmHg). The mean pulmonary to systemic flow ratio was 2.6±0.8 (range 1.7 to 5), and the mean cardiothoracic ratio was 0.6±0.1 (range 0.5 to 0.7). Most of the defects (72.2%) were repaired with primary sutures. Eight patients underwent repair and aortocoronary bypass for concomitant cardiac lesions. Intra- and postoperative intrapulmonary nitroglycerine, prostacyclin, and inotropic support were required for hemodynamic stability in six patients, respectively. The mean follow-up was 8.2±4.4 years (range 1 months to 16.9 years). Results: Twelve patients (33.3%) developed nonfatal complications. Major cardiovascular events were not encountered in 33 patients (91.7%). Functional capacity improved in 30 patients (83.3%) and the median NYHA class decreased from III to I (p

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