Pediatrik Yaş Grubunda Normotermik Kardiyopulmoner By-Pass ve Normotermik Kan Kardiyoplejisi İle Atriyal Septal Defekt Cerrahisi

Öz

Amaç: Bu çalışmanın amacı, pediatrik yaş grubundaki hastalarda, normotermik kardiyopulmoner bypass ve normotermik kan kardiyoplejisi kullanılarak yapılan atriyal septal defekt ASD kapatılması operasyonlarının sonuçlarını sunmaktır. Gereç ve Yöntemler: 2014-2017 yılları arasında 62 pediatrik hastaya 37 kadın ve 25 erkek, ortalama yaş 7,6±4,6 yıl, ortalama vücut ağırlığı 27,09±18,4 kg normotermik kardiyopulmoner bypass ve normotermik kan kardiyoplejisi kullanılarak ASD kapatılması operasyonu yapıldı. Hastalarda mini cilt insizyonu ve median 3/4 üst parsiyel sternotomi kullanıldı. Kardiyopulmoner bypass esnasında nazofarengeal ısı 35-37 °C arasında tutuldu ve normotermik kan kardiyoplejisi 10 ml/kg olarak uygulandı. Bulgular: Saptanan ASD tipleri; 8 “low venosum” tip, 54 “sekundum” tip olup, ortalama Qp/Qs değerleri; 2,57±1,2, ortalama pulmoner arter basıncı değerleri; sistolik, 31,88±6,6 mmHg, diyastolik, 11,0±2,6 mmHg ve ortalama, 18,54±3,8 mmHg’dir. 51 hastada primer, 11 hastada taze perikard yama ile kapatma yöntemi kullanılmış olup, ortalama kardiyopulmoner bypass süresi 26,04±10,8 dk ve aortik klemp süresi 15,38±8,2 dk olarak saptanmıştır. Yirmisekiz hasta operasyon masasında ekstübe edilmiş olup, pediatrik yoğun bakım ünitesinde ekstübe edilen 34 hastanın ortalama ekstübasyon süresi 3,02±2,9 saattir. Hastaların ortalama drenaj miktarı 58,95±44,3 ml olarak tespit edilmiş olup, postoperatif dönemde kan ürünü verilme ihtiyacı olan hasta olmamıştır. Ortalama yoğun bakım kalış süreleri 1,3±0,4 gün olarak bulunmuştur. Ortalama hastanede kalış süresi 4,3±1 gün olarak saptanmıştır. Sonuç: Elde edilen sonuçlar normotermik kardiyopulmoner bypass ve normotermik kan kardiyoplejisinin, pediatrik yaş grubundaki hastalarda uygulanan ASD kapatılması operasyonlarında güvenle kullanılabileceğini düşündürmektedir

Anahtar Kelimeler

• Atrial Septal Defekt, Kan Kardiyoplejisi, Normotermik, Pediatrik, Kalp Cerrahisi

Atrial Septal Defect Surgery With Normothermic Cardiopulmonary Bypass and Normothermic Blood Cardioplegia in the Pediatric Age Group

Abstract

Objective: The aim of this study is to present the outcomes of atrial septal defect ASD closure operations performed using normothermic cardiopulmonary bypass and normothermic blood cardioplegia in patients in the pediatric age group.Material and Methods: Between 2014 and 2017, 62 pediatric patients 37 females, 25 males, mean age 7.6±4.6 years-body weight 27.09±18.4 kg received normothermic cardiopulmonary bypass and normothermic blood cardioplegia during an ASD closure operation. A mini-skin incision and median 3/4 upper partial sternotomy were used. During cardiopulmonary bypass, nasopharyngeal temperature was maintained at 35-37°C and normothermic blood cardioplegia was administered at 10 ml/kg.Results: The ASD was ‟low venosum” type in 8 patients and ‟secundum” type in 54 patients. The average Qp/Qs value was 2.57±1.2 and mean pulmonary artery pressure values were systolic 31.88±6.6 mmHg, diastolic 11.0±2.6 mmHg, general mean 18.54±3.8 mmHg. Primary closure was used in 51 patients and a fresh pericardial patch was used in 11 patients. Mean cardiopulmonary bypass time was 26.04±10.8 min and aortic clamp time was 15.38±8.2 min. Twenty-eight patients were extubated on the operation table and the mean extubation time of 34 patients who were extubated in the pediatric intensive care unit was 3.02±2.9 hours. The mean drainage volume of the patients was 58.95±44.3 ml, and none of the patients needed transfusion of blood products in the postoperative period. Mean duration of intensive care stay was found to be 1.3±0.4 days. The mean duration of hospital stay was 4.3±1 days.Conclusion: The results suggest that normothermic cardiopulmonary bypass and normothermic blood cardioplegia may be used safely in ASD closure operations performed in the pediatric age group

Keywords

• Atrial Septal Defect, Blood Cardioplegia, Normothermia, Pediatric, Cardiac Surgery

Kaynakça

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