Sol ventrikül anevrizmalarında cerrahi tedavi sonuçlarımız

Yıl 2004, Cilt: 1 Sayı: 3, 26 - 30, 01.04.2004

Alper Sami Kunt Osman Tansel Darçın Salih Aydın Deniz Demir Cüneyt Şelli

Öz

Amaç: Sol ventrikül anevrizmalarının cerrahi tamiri hayat kalitesi ve uzun süre sağkalım üzerine olumlu etkileri vardır. Çalışmamız, kliniğimizde sol ventrikül anevrizma tanısı ile cerrahi tedavi uygulanan olguların erken dönem sonuçlarını sunmak amacıyla düzenlenmiştir. Gereç-Yöntem: Merkezimizde 2002 ve 2004 yılları arasında yaş ortalamaları 58.53 ± 10.78 yıl olan sol ventrikül anevrizmalı 17 olguya anevrizma onarımı uygulanmıştır. Olguların preoperatif, postoperatif ekokardiyografik olarak sol ventrikül ejeksiyon fraksiyonları LVEF değerlendirilmiştir. Olguların tümünde lineer plikasyon uygulanmıştır. Takiplerin tümü poliklinik kontrolleri ile yapılmıştır. Bulgular: Postoperatif en sık karşılaşılan komplikasyon 5 olguda % 29.41 tedavi gerektiren ventriküler ve atriyal aritmilerdir. Preoperatif olguların % 17.64 NYHA klas I-II ve % 82.35 ise NYHA klas III-IV olup ortalama sol ventrikül ejeksiyon fraksiyonu %33.39 ± 5.97 bulundu. Anteroapikal anevrizma 15 olguda % 88.23 ve posterobazal anevrizma 2 olguda % 11.76 saptanmıştır. Olguların tümünde koroner arter bypass cerrahisi uygulandı. Postoperatif izlemlerde olguların% 82.35’de fonksiyonel kapasiteleri NYHA klas I-II, % 17.64 NYHA klas III-IV olarak değerlendirilirken ve ortalama ejeksiyon fraksiyonu % 43.31 ± 4.26 olarak bulundu. Sonuç: Sol ventrikül anevrizmalarının onarımı revaskülarize edilen koroner arter sayısı fazlalığının, dolayısı ile multidamar koroner hastalığının önemli bir risk faktörü olmasına rağmen erken dönemde mortalite ve morbiditeyi azaltmaktadır.

Anahtar Kelimeler

Sol ventrikül anevrizması, Koroner arter bypass cerrahisi, lineer plikasyon

Results of surgıcal treatment in patıents with left ventrıcular aneurysm

Öz

Background: Aneurysm repair is an important therapeutic intervention which improves the survival and life quality of patients with left ventricular aneurysm. In this study, we present our early results of patients with the left ventricular aneurysm which treated surgically. Methods: Between January 2001 and October 2002, 17 patients underwent surgical repair for postischemic left ventricular aneurysm. Fifteen 88.2% of the patients were male and mean age was 58.53 ± 10.78 years. Linear closure employed in all patients. Complete coronary revascularization was routinely added in all cases. Results: There was no early mortality. Low cardiac output developed in 5 % 29.41 patients and treated by inotropic agents and 2 of them intraaortic balloon pump support. Atrial fibrillation and ventricular arrhytmia developed in 5 29.41% of the patients and all of them converted to sinus rhythm with antiarhythmic agents. Average stay in intensive care unit and hospital stay were 2.83 ± 1.29 and 7.74 ± 2.14 days, respectively. Functional status improved in all patients. Conclusions: Regardless repair method left ventricular aneurysm repair combined with complete coronary revascularization can be performed safely with reliable improvements regarding survival and functional status.

Anahtar Kelimeler

Left ventricular aneurysm, Coronary artery bypass surgery, Lineer closure

Kaynakça

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