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

Year 2017, Volume: 20 Issue: 1, 72 - 74, 03.04.2017

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

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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