Valve Replacement Performed on the Beating Heart with Continuous Retrograde Coronary Sinus Isothermic Blood Perfusion Combined with Coronary Bypass

Abstract

An operation on the beating heart was planned for a 60-year-old woman who applied to our clinic with aortic stenosis, three vessel coronary artery disease and poor left ventricular function. There are reports about beating heart valve surgery perfomed alone or combined with coronary artery bypass operations using continuous retrograde coronary sinus isothermic blood perfusion in patients with poor ventricle. We performed a coronary revascularization process for three-vessel disease on the pump beating heart and aortic valve replacement under cross-clamp using continuous retrograde coronary sinus isothermic blood perfusion in the same session. She was discharged on the sixth postoperative day after an uneventful recovery. She is well and active 24 months after the operation. Valve replacement using the retrograde coronary sinus isothermic blood perfusion technique due to its protective effect on the already borderline myocardial functions in patients with poor ventricles is a useful and clinically successful method.

Keywords

• Aortic valve; coronary sinus; coronary artery bypass.

Çalışan Kalpte Sürekli Retrograd Koroner Sinüs İzotermik Kan Perfüzyonu ile Aort Kapak Replasmanıyla Kombine Koroner Baypas

Abstract

Altmış yaşında kadın hastaya global hipokinezisi ve aort kapak darlığı nedeniyle çalışan kalpte koroner baypas ve aort kapak replasmanı planlandı. Bir süredir çeşitli yayınlarda koroner baypasla birlikte ya da tek başına aort kapak replasmanın başarılı bir şekilde çalışan kalpte yapıldığına dair makaleler yer almaktaydı. Ciddi kalsifik aort darlığı (kapak alanı 0.7 cm²'nin altında), üç damar koroner revaskülarizasyona gereksinimi olan hastaya çalışan kalpte pompa destekli koroner baypas ve aynı seansta kross-klemp altında sürekli retrograd koroner sinüs izotermik kan perfüzyonu ile aort kapak replasmanı gerçekleştirdik. Altmış yaşındaki hastanın hipertansiyonu ve diabetes mellitus komorbiditesi vardı. Geçirdiği miyokart enfarktüsü ejeksiyon fraksiyonunu azaltmıştı. Hasta yapılan üçlü baypas ve hemen sonrasında icra edilen aort kapak replasmanı ile altı gün hastane kalış süresi sonunda kendi işlerini yürütebilecek şekilde taburcu edildi. Hasta postoperatif 24. ayında sağlıklı şekilde izlenmektedir. Son zamanlarda uygulanan, morbidite ve mortaliteyi düşüren, kötü ventriküllü hastalarda akılda tutulması gereken bir tekniği hatırlatması açısından bu olguyu sunmaya değer bulduk.

Keywords

• Aort kapak; koroner sinüs; koroner arter baypas.

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