Kalp Kateterizasyonu Yapılan Çocuklarda Kateter Giriş Yerine Ait Vasküler Komplikasyonlar

Year 2012, Volume: 6 Issue: 1, 23 - 30, 01.12.2012

Birsen Uçar Zübeyir Kılıç Zehra Karataş

Abstract

Giriş: Kardiyak kateterizasyondan sonra kateter giriş yerinde tromboz, psödoanevrizma, diseksiyon, laserasyon, arteriyovenöz fistül, kanama, enfeksiyon ve distal embolizasyon gibi lokal komplikasyonlar görülebilir.Yöntem: Kliniğimizde Mayıs 2003 - Mayıs 2006 yılları arasında kalp kateterizasyonu yapılan 178 hastanın kayıtları ponksiyon yerinde gelişen lokal komplikasyonların özellikleri, tedavi yaklaşımları ve eşlik eden risk faktörleri yönünden retrospektif olarak incelendi.Bulgular: Hastaların, yaşları 3 gün ile 17 yaş arasında değişmekte (ortalama 5.3 ± 4.9 yaş) olup, 101’i kız, 77’si erkek idi. Hastaların 125 (% 70.2)’ine tanısal, 53 (% 29.7)’üne girişimsel işlem amacıyla kalp kateterizasyonu yapıldı. Kateterizasyondan sonraki ilk 24 saat içinde komplikasyon gelişen 7 (% 3.9) hastanın yaşları 6 ay ile 6 yaş arasında değişmekteydi (ortalama 2.4 ± 0.7 yaş). İki hastada diseksiyon ve tromboz, beş hastada ise tromboz gelişti. Komplikasyon gelişen hastalardan beşine tanısal, ikisine girişimsel amaçlı kateterizasyon yapılmıştı. Bu hastalardan biri heparin ve doku plazminojen aktivatörü (t-PA) infüzyonları ile tedavi edilirken, ikisi sadece heparin infüzyonu ile, diğer 4 hasta da heparin ve streptokinaz infüzyonları ile tedavi edildi. Üç hastaya (birinde tromboz, diğer ikisinde diseksiyon ve tromboz) trombektomi yapıldı. Diseksiyonu olan hastalardan birine safen ven ile yama anjiyoplasti yapıldı. Komplikasyonların; Down sendromu olmayan 170 hastanın beşinde (%2.9), Down sendromu olan sekiz hastanın ise ikisinde (%25) geliştiği görüldü (p<0.05).Sonuç: Kalp kateterizasyonu yapılan hastaların lokal vasküler komplikasyonlar yönünden yakın takibinin ve tromboz saptanan olguların, antitrombotik ve fibrinolitik ajanlarla erken dönemde tedavi edilmesinin, gerekli hastaların ise zamanında cerrahiye verilmesinin hastaların sekelsiz olarak iyileşmesi açısından son derece önemli olduğu, ayrıca Down sendromunun bu hastalarda tromboz oluşumunu artıran bir risk faktörü olduğu düşünüldü.

Keywords

Kardiyak kateterizasyon, lokal vasküler komplikasyon, çocuk

VASCULAR COMPLICATIONS BELONGING TO CATHETER INSERTION IN CHILDREN WHO UNDERWENT CARDIAC CATHETERIZATION

Abstract

Introduction: Local complications such as thrombosis, pseudoaneursym, dissection, laceration, anteriovenous fistule, hemorrhage, infection, and distal embolization can be observed after cardiac catheterization (CC). The aim of the study is to evaluate these complications in our patients. Methods: The medical records of 178 patients underwent CC in our clinic between May 2003-May 2006 were retrospectively evaluated for local complications, treatment approaches, and associated risk factors. Results: The mean age of the patients was 5.3 ± 4.9 years (3 days-17 years); 101 were female and 77 were male. CC were performed in 125 (70.2%) patients for diagnostic purposes and 53 (29.7%) patients for therapeutic interventions. During 24 hours after CC, some complications developed in 7 (3.9%) cases with a mean age of 2.4±0.7 years (6 months-6 years). Thrombus was determined in 5 patients and dissection with thrombus was determined in 2 patients. These complications were observed in 5 patients underwent diagnostic CC and in 2 patients underwent therapeutic CC. Two cases were treated with only heparin infusion, whereas one patient was treated with both heparin and tissue plasminogen activator (t-PA) infusion. Additionally, 4 patients treated with heparin and streptokinase infusion. Thrombectomy was performed in 1 patient with thrombus and 2 patients with dissection and thrombus. The saphenous vein patch angioplasty has also been performed in 1 patient with dissection. These complications were determined in 5 of 170 patients (2.9%) without Down syndrome and in 2 of 8 patients (25%) with Down syndrome (p<0.05).Conclusions: Patients who underwent cardiac catheterization should be closely follow up for development of local vascular complications. If a thrombus was developed as a complication, this should be promptly treated with antithrombotic and fibrinolitic agents in early period and appropriate surgery should be performed on time. These measures are very important for the recovery of the patients without sequela. Furthermore, Down syndrome may be a risk factor for thrombus formation in these patients

Keywords

Cardiac catheterization, local vascular complication, child

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