KARDİYAK FİBRİLASYON ALTINDA REOPERASYON MİTRAL KAPAK REPLASMANI: ÜÇÜNCÜ KEZ AÇIK KALP AMELİYATI YAPILAN BİR OLGU SUNUMU

Yıl 2023, Cilt: 5 Sayı: 2, 62 - 65, 31.12.2023

Mehmet Işık Ali Demiray Ömer Tanyeli Yüksel Dereli Niyazi Görmüş

Öz

Reoperasyon kalp cerrahisi vakalarında, parakardiyak ve aort çevresi dokularda ileri derecede yapışıklıklar olabilmekte ve bu durum rutin kanulasyon protokolünü engelleyebilmektedir. Bu nedenle farklı cerrahi protokoller gerekebilmektedir. Bu çalışmada 29 yıl önce mekanik aort kapak replasmanı, 5 yıl önce, asendan aort replasmanı ve şimdide mitral kapak replasmanı yapılan bir olgu sunuldu. Hasta dispne, çabuk yorulma ve halsizlik şikayetleri ile başvurdu. Yapılan ekokardiyografide ileri mitral yetmezliği saptandı ve mitral kapak replasmanı kararı verildi. Hastanın ikinci ameliyatında asendan aortaya dacron greft yerleştirilmişti. Greft nedeniyle asendan aort çevre dokulara ileri derecede yapışıktı. Bu yüzden aortaya kros klemp konulamadı ve rutinin dışında farklı bir cerrahi prosedür uygulanması gereksinimi doğdu. Hastaya sol femoral kanulasyon ve total sirkulatuar arrest altında, kross klemp konulmadan ve kardiyak fibrilasyonda mekanik mitral kapak replasmanı yapıldı. Postoperatif 9. Günde şifa ile taburcu edildi.

Anahtar Kelimeler

Reoperasyon, kalp cerrahisi, mitral kapak replasmanı

Destekleyen Kurum

Yok

REOPERATION MITRAL VALVE REPLACEMENT UNDER CARDIAC FIBRILATION: A CASE REPORT WITH A THIRD OPEN HEART SURGERY

Öz

In reoperation heart surgery cases, there may be advanced adhesions in the paracardiac and surrounding aortic tissues, and this may prevent the routine cannulation protocol. Therefore, different surgical protocols may be required. In this study, a case of mechanical aortic valve replacement 29 years ago, ascending aortic replacement 5 years ago, and now mitral valve replacement is presented. The patient presented with complaints of dyspnea, fatigue and weakness. Advanced mitral regurgitation was detected in echocardiography, and mitral valve replacement was decided. In the second operation of the patient, a dacron graft was placed in the ascending aorta. The ascending aorta was highly adherent to the surrounding tissues due to the graft. Therefore, a cross-clamp could not be placed on the aorta and a different surgical procedure was required outside the routine. Mechanical mitral valve replacement was performed in the patient under left femoral cannulation and total circulatory arrest, without cross-clamping and in cardiac fibrillation. He was discharged on the 9th postoperative day with good recovery.

Anahtar Kelimeler

Reoperation, cardiac surgery, mitral valve replacement

Kaynakça

• Beebeejaun MY, Malec A, Gupta R, Alkhawam H. Conservative management of chronic aortic dissection with underlying aortic aneurysm. HeartInt. 2013 Mar 15;8(1):e4.
• Brown JA, Kilic A, Aranda-Michel E, Navid F, Serna-Gallegos D, Bianco V, et al.. Long-Term Outcomes of Reoperation for Bleeding After Cardiac Surgery. Semin Thorac Cardiovasc Surg. 2021 Autumn;33(3):764-773.
• Cohn LH, Peigh PS, Sell J, DiSesa VJ. Right thoracotomy, femoro femoral bypass, and deep hypothermia for re-replacement of the mitral valve. Ann Thorac Surg. 1989 Jul;48(1):69-71.
• Dereli Y, Özdemir R, Kayalar N, Ağrış M, Hoşgör K, Özdiş S. Open Heart Surgery in Konya State Hospital: Review of The First 550 Cases. Selcuk Med J. 2014;30(2): 58-63.
• Husebye DG, Pluth JR, Piehler JM, Schaff HV, Orszulak TA, Puga FJ, et al.. Reoperation on prosthetic heart valves. An analysis of risk factors in 552 patients J Thorac Cardiovasc Surg. 1983;86:543–52.
• Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, Winterhalter M, Hoy L, Haverich A, Hagl C. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008 Apr;135(4):908-14.
• Kızıltan HT, İdem A, Salihi S, Demir AS, Korkmaz AA, Güden M. Mitral valve surgery using video-assisted right mini thoracotomy and deephy pothermic perfusion in patients with previous cardiac operations. J Cardiothorac Surg. 2015 Apr17;10:55.
• LaPar DJ, Ailawadi G, Harris DA, Hajzus VA, Lau CL, Kern JA, Kron IL. A protocol- driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy. Ann Thorac Surg. 2013 Sep; 96(3):865-70
• Moon MR, Henn MC, Maniar HS, Pasque MK, Melby SJ, Kachroo P, et al.. Impact of Surgical Experience on Operative Mortality After Reoperative Cardiac Surgery. Ann Thorac Surg. 2020 Dec;110(6):1909-1916.
• Seeburger J, Borger MA, Falk V, Passage J, Walther T, Doll N, et al.. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg. 2009;67:709–14.