Arteryel Switch Operasyonlarında Aortopulmoner Çap Uyumsuzluğunu Gidermek İçin Nonkoroner Sinüs Plikasyonu

Yıl 2024, Cilt: 21 Sayı: 1, 67 - 72, 29.04.2024

Onur Doyurgan Ahmet Kuddusi İrdem Yiğit Kılıç Fatih Özdemir Hasan Balık Osman Akdeniz

https://doi.org/10.35440/hutfd.1330996

Öz

Öz
Amaç: Ciddi aortopulmoner çap uyumsuzluğu arteryel switch operasyonu sırasında karşılaşılan bir problemdir. Sinotubuler bileşke geometrisini bozarak postoperatif neoaortik kapak yetmezliğine neden olabilir. Bu çalışmada aortopulmoner çap uyumsuzluğunu gidermek için uyguladığımız cerrahi teknikleri ve bu prosedürün sonuçlarını inceledik. Materyal ve metod: Hastanemizde Aralık 2017-Mayıs 2023 tarihleri arasında büyük arter transpozisyonu (BAT) tanısı ile opere edilen hastalar arasından pulmoner arter / aort çap uyuşmazlığını gidermeye yönelik cerrahi prosedür uygulanan hastalar çalışmaya alındı. Hastalar nonkoroner sinüs plikasyonu yapılanlar ve diğer teknikler uygulananlar olarak iki gruba ayrıldı. Pulmoner arter / aort çap uyuşmazlığı sinotubuler bileşkede pulmoner arter çapının aorta çapının iki katından fazla olması olarak tanımlandı. Bulgular: Arteryel switch operasyonu yapılan 127 hastadan 23’ünde (%18,1) aortopulmoner çap uyumsuzluğu mevcuttu. Aortopulmoner çap uyumsuzluğu olan hastaların 15’ine (%65,2) nonkoroner sinüs plikasyonu, 5’ine (%21,7) aort anterior duvarına longitudinal insizyon ile genişletme, 2’sine (%8,7) pulmoner arterden doku rezeksiyonu ve 1’ine (%4,4) aort anterior duvarda otolog perikard yama ile genişletme yapıldı. Hastaların 15’i erkek, ortanca yaşı 14 gün ve ortanca ağırlığı 3,3 kg olarak saptandı. Hastaların 9’u basit BAT iken 10 hastada büyük arter transpozisyonuna ventriküler septal defekt, 4 hastada Taussig-Bing anomalisi, 4 hastada aortik ark patolojisi eşlik ediyordu. İki hasta sol ventrikül disfonksiyonu nedeniyle ve bir hasta sepsis nedeniyle yaşamını yitirdi. Gruplar arasında perioperatif veriler açısından anlamlı farklılık bulunmadı. Takipte hafif neoaortik kapak yetmezliği oranı nonkoroner sinüs plikasyonu yapılan hastalarda %33,3 (n=5), diğer tekniklerin uygulandığı hastalarda %37,5 (n=3) bulundu. Hiçbir hastada neoaortik kapak darlığı veya orta/ciddi neoaortik kapak yetmezliği saptanmadı. Sonuç: Nonkoroner sinüs plikasyonu arteryel switch operasyonlarında aortopulmoner çap uyumsuzluğunu gidermeye yönelik basit, düşük riskli ve uygulaması kolay bir prosedürdür. Bu teknik kullanılarak aort ve pulmoner arter arasındaki asimetri ortadan kaldırılabilir ve daha doğal bir anatomi oluşturulması sağlanabilir.

Anahtar Kelimeler

büyük arter transpozisyonu, arteryel switch operasyonu, aort, pulmoner arter

Noncoronary Sinus Plication to Correct Aortopulmonary Diameter Mismatch in Arterial Switch Operations

Öz

Background: Severe aortopulmonary diameter mismatch is a problem encountered during arterial switch operation. It may cause postoperative neoaortic valve insufficiency by disrupting the geometry of the sinotubular junction. In this study, we analyzed the surgical techniques and outcomes of aortopulmonary diameter mismatch.
Materials and Methods: Patients who underwent surgical procedures to correct pulmonary artery/aortic diameter mismatch between December 2017 and May 2023 in our hospital were included in the study. Patients were divided into two groups as those who underwent noncoronary sinus plication and those who underwent other techniques. Pulmonary artery/aortic diameter mismatch was defined as a pulmonary artery diameter more than twice the diameter of the aorta at the sinotubular junction.
Results: Aortopulmonary diameter mismatch was present in 23 (18.1%) of 127 patients who underwent arterial switch opera-tion. Of the patients with aortopulmonary diameter mismatch, 15 (65.2%) underwent noncoronary sinus plication, 5 (21.7%) underwent dilatation through a longitudinal incision in the anterior aortic wall, 2 underwent tissue resection from the pulmo-nary artery, and 1 (4.4%) underwent dilatation with an autologous pericardial patch in the anterior aortic wall. Fifteen patients were male (p=0,371), median age was 14 days (p=0,825) and median weight was 3.3 kg (p=0,392). While 9 patients had simple TGA, transposition of the great arteries was associated with ventricular septal defect in 10 patients, Taussig-Bing anomaly in 4 patients and aortic arch pathology in 4 patients. Two patients died due to left ventricular dysfunction and one patient died due to sepsis. There was no significant difference in perioperative data between the groups. The rate of mild neoaortic valve regurgitation at follow-up was 33.3% (n=5) in patients with noncoronary sinus plication and 37.5% (n=3) in patients with other techniques (p=0,842). Neoaortic valve stenosis or moderate/severe neoaortic valve insufficiency was not detected in any patient.
Conclusions: Surgical techniques used to correct aortopulmonary diameter mismatch have similar results. Noncoronary sinus plication is a simple, low-risk and easy-to-perform procedure to correct aortopulmonary diameter mismatch in arterial switch operations. Using this technique, the asymmetry between the aorta and pulmonary artery can be eliminated and a more natural anatomy can be created.

Key Words: Transposition of great arteries, Arterial switch operation, Aorta, Pulmonary artery

Anahtar Kelimeler

Transposition of great arteries, Arterial switch operation, Aorta, Pulmonary artery

Kaynakça

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