Mitral Kapak Değiştirilmesi Sonrası Gelişen Sol Ventrikül Yırtılmasına Yaklaşım
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Tarih
2007
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info:eu-repo/semantics/openAccess
Özet
Amaç: Sol ventrikül yırtığı (SVY), mitral kapak değiştirilmesi (MKD) sonrası gelişen en ciddi komplikasyonlardan biridir. Bu çalışmada, dört yıllık bir süre içinde MKD sonrası SVY gelişen olgular değerlendirildi. Çalışma planı: Mayıs 2000-Mayıs 2004 tarihleri arasında, MKD uygulanan 218 hastanın dördünde (4 kadın; ort. yaş 538) SVY gelişti. Yırtılma iki hastada erken dönemde, ikisinde geç dönemde görüldü. Üç hastaya cerrahi onarım uygulandı. Bu olgularda yırtılma tip I idi. Tekrar ameliyat edilen bir olguda ise yetersiz süreden dolayı cerrahi onarım uygulanamadı. Cerrahi onarıma kardiyopulmoner bypass (KPB) desteğinde ve kalp durdurularak başlandı. Sol atriyum tekrar açıldı ve protez kapak çıkartıldı. Onarımda, ventrikül ve atriyum tarafında Teflon feltler kullanılarak, horizontal U dikişlerle yırtık kapatıldı. Onarımdan sonra, değiştirilen protez kapağın bir küçük boyu yerleştirildi. Bulgular: Onarım yapılan üç olguda da ana patoloji romatizmal mitral kapak darlığı idi ve sadece MKD uygulandı. Onarım uygulanamayan hastaya ise, açık mitral komissürotomi sonrası tekrarlayan mitral darlığı, aort yetmezliği ve sol atriyal trombüs nedeniyle MKD, aort kapak değiştirilmesi ve sol atriyal trombektomi yapıldı. Onarım uygulanan iki olgu, herhangi bir kalp yetmezliği bulgusu göstermeksizin hastaneden taburcu edildi. İki hasta kaybedildi. Sonuç: Mitral kapak değiştirilmesi sırasında mitral kapak arka yaprağının korunması, derin yerleşimli miyokardiyal dikişlerden kaçınılması, mitral kapak annulusunun çekiştirilmesinin en aza indirilmesi ve hava çıkarma sırasında, kalbin aşırı hareketinden kaçınılması, SVY’nin önlenmesi için önemli tedbirlerdir. Sol ventrikül yırtığı onarımı, KPB desteğinde ve durdurulmuş kalpte yapılmalıdır.
Background: Left ventricular rupture (LVR) is one of the most severe complications following mitral valve replacement (MVR). In this study, we evaluated patients who developed LVR after MVR within a four-year period. Methods: Between May 2000 and 2004, a total of 218 patients underwent MVR. Of these, LVR developed in four patients (4 females; mean age 53±8 years) in the early (n2) and late (n2) postoperative period. Surgical repair was performed in three patients who had type I ruptures. Repair was not possible in one patient due to insufficiency of time. Surgical repair was commenced with reinstitution of cardiopulmonary bypass (CPB) and induced heart arrest. The left atrium was reopened and the prosthesis was removed. During repair, Teflon felt strips were used on the ventricular and atrial sides and the rupture was closed by interrupted horizontal mattress sutures. After the repair procedure, mitral prosthesis was replaced with one of a smaller size. Results: In three patients who underwent a repair operation, the main pathology was rheumatic mitral valve stenosis, and only MVR was performed. The remaining patient underwent MVR without repair, as well as aortic valve replacement, and left atrial thrombectomy due to recurrent mitral stenosis, mitral and aortic regurgitation, and left atrial thrombus after a previous open mitral commissurotomy. Following surgical repair, two patients were discharged without any sign of cardiac failure. The remaining two patients died. Conclusion: During mitral valve replacement, preservation of the posterior leaflet of the mitral valve, avoidance of deeply placed myocardial sutures, minimal traction of the mitral valve annulus, and avoidance of undue manipulation of the heart during de-airing are important measures to prevent LVR. Repair for LVR should be accomplished with the aid of CPB on the arrested heart.
Background: Left ventricular rupture (LVR) is one of the most severe complications following mitral valve replacement (MVR). In this study, we evaluated patients who developed LVR after MVR within a four-year period. Methods: Between May 2000 and 2004, a total of 218 patients underwent MVR. Of these, LVR developed in four patients (4 females; mean age 53±8 years) in the early (n2) and late (n2) postoperative period. Surgical repair was performed in three patients who had type I ruptures. Repair was not possible in one patient due to insufficiency of time. Surgical repair was commenced with reinstitution of cardiopulmonary bypass (CPB) and induced heart arrest. The left atrium was reopened and the prosthesis was removed. During repair, Teflon felt strips were used on the ventricular and atrial sides and the rupture was closed by interrupted horizontal mattress sutures. After the repair procedure, mitral prosthesis was replaced with one of a smaller size. Results: In three patients who underwent a repair operation, the main pathology was rheumatic mitral valve stenosis, and only MVR was performed. The remaining patient underwent MVR without repair, as well as aortic valve replacement, and left atrial thrombectomy due to recurrent mitral stenosis, mitral and aortic regurgitation, and left atrial thrombus after a previous open mitral commissurotomy. Following surgical repair, two patients were discharged without any sign of cardiac failure. The remaining two patients died. Conclusion: During mitral valve replacement, preservation of the posterior leaflet of the mitral valve, avoidance of deeply placed myocardial sutures, minimal traction of the mitral valve annulus, and avoidance of undue manipulation of the heart during de-airing are important measures to prevent LVR. Repair for LVR should be accomplished with the aid of CPB on the arrested heart.
Açıklama
Anahtar Kelimeler
Cerrahi, Kalp ve Kalp Damar Sistemi, Kalp yırtığı/cerrahi, kalp kapağı protez implantasyonu, kalp ventrikülü, mmitral kapağı/cerrahi, ameliyat sonrası komplikasyon, yırtık, spontan, Heart rupture/surgery, heart valve prosthesis implantation, heart ventricles, mitral valve/surgery, postoperative complications/surgery, rupture, spontaneous
Kaynak
Türk Göğüs Kalp Damar Cerrahisi Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
15
Sayı
3
Künye
Narin, C., Reyhanoğülu, H., (2007). Mitral Kapak Değiştirilmesi Sonrası Gelişen Sol Ventrikül Yırtılmasına Yaklaşım. Türk Göğüs Kalp Damar Cerrahisi Dergisi, 15(3), 202-206.
