Ventriküler Septal Defekt ve Aort Kapak Yetmezliği ile Komplike olan Rüptüre Valsalva Sinüsü Anevrizmasına Cerrahi Yaklaşım

Abstract

Yirmi üç yaşındaki erkek hasta 2 haftalık konjestif kalp yetmezliği öyküsü ile yatırıldı. Ekokardiyografide, sağ valsalva sinüsünden köken alan anevrizma ile ventriküler septal defekt ve ciddi aort kapak yetmezliği saptandı ve cerrahiye karar verildi. Sağ valsalva sinüsü içeriden onarıldı. Kontinü dikiş tekniği ile perikard yaması kullanılarak, ventriküler septal defekt ve daha önce onarılan sağ valsalva sinüsü de dahil edilecek şekilde infundibulotomi onarıldı. Aortik pozisyona mekanik kapak takıldı. Postop takipte sıkıntısı olmayan hasta 12. günde taburcu edildi. Aort kapak yetmezliği ve yüksek debili şant; ventrikül çapında artışa, ejeksiyon fraksiyonunda bozulmaya, konjestif kalp yetmezliğine ve bunun neden olduğu pulmoner semptomlara yol açar. Ventrikül genişlemesi ya da düşük ejeksiyon fraksiyonu, bu hastalarda inoperabilite nedenleri değildir.

Keywords

• Valsalva sinüsü,rüptür,aort kapak yetmezliği,konjestif kalp yetmezliği

Surgical Repair of a Ruptured Sinus of Valsalva Aneurysm Complicated by Ventricular Septal Defect and Aortic Valve Insufficiency

Abstract

A 23-year-old male patient was admitted with a 2-week history of congestive heart failure. An echocardiogram revealed an aneurysm originating from the right sinus of Valsalva with a small perforated area on the edge, a ventricular septal defect and severe aortic valve insufficiency. A decision for surgery was made. The right sinus of Valsalva was repaired from the inside. The infundibulotomy was closed using a continuous suturing technique and pericardial patch was used incorporating the ventricular septal defect and the previously repaired right sinus of Valsalva. The aortic valve was replaced with a mechanical prosthesis. Follow-up was unproblematic, and he was discharged on the 12^th postoperative day. Aortic valve insufficiency and a high output shunt cause an increase in the ventricular diameter, impairment of the ejection fraction, congestive heart failure and resultant pulmonary pathology. Ventricular enlargement or impaired ejection fraction does not necessarily deem these patients inoperable.

Keywords

• Anıl Özen,Aytaç Çalışkan,Ertekin Utku Ünal,Erman Kiriş,Bahadır Aytekin,Cemal Levent Birincioğlu

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