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

Yıl 2017, Cilt: 20 Sayı: 1, 72 - 74, 03.04.2017

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

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Au WK, Chiu SW, Mok CK, Lee WT, Cheung D, He GW. Repair of ruptured sinus of valsalva aneurysm: determinants of long-term survival. Ann Thorac Surg 1998;66:1604-10.
• 2. Yacoub MH, Kha n H, Stavri G, Shinebourne E, Radley-Smith R. Anatomic correction of the syndrome of prolapsing right coronary aortic cusp, dilatation of the sinus of Valsalva, and ventricular septal defect. J Thorac Cardiovasc Surg 1997;113:253-60.
• 3. Abe T, Komatsu S. Surgical repair and long-term results in ruptured sinus of valsalva aneurysm. Ann Thorac Surg 1988;46:520-5.
• 4. Meyer J, Wukasch DC, Hallman GL, Cooley DA. Aneurysm and fistula of the sinus of Valsalva clinical considerations and surgical treatment in 45 patients. Ann Thorac Surg 1975;19:170-9.
• 5. Guo HW, Sun XG, Xu JP, Xiong H, Wang XQ, Su WJ, et al. A new and simple classification for the non-coronary sinus of Valsalva aneurysm. Eur J Cardiothorac Surg 2011;40:1047-51.
• 6. Sarikaya S, Adademir T, Elibol A, Büyükbayrak F, Onk A, Kirali K. Surgery for ruptured sinus of Valsalva aneurysm: 25-year experience with 55 patients. Eur J Cardiothorac Surg 2013;43:591-6.
• 7. Azakie A, David TE, Peniston CM, Rao V, Williams WG. Ruptured sinus of Valsalva aneurysm: early recurrence and fate of the aortic valve. Ann Thorac Surg 2000;70:1466-71.
• 8. Edwards JE, Burchell HB. The pathological anatomy of deficiencies between the aortic root and the heart, including aortic sinus aneurysms. Thorax 1957;12:125-39.
• 9. Barragry TP, Ring WS, Moller JH, Lillehei CW. 15- to 30-year follow-up of patients undergoing repair of ruptured congenital of the sinus of Valsalva aneurysms. Ann Thorac Surg 1988;46:515-9.
• 10. Dong R, Chen BT, Meng X, Liu TS, Song Y, Zheng JB, et al. Long-term results of surgical repair of ruptured sinus of aortic sinus aneurysm. Zhonghua Wai Ke Za Zhi 2008;46:1913-5.
• 11. Liu YG, Liu AJ, Ling F, Wang D, Zhu YB, Wang Q, et al. Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm. Ann Thorac Surg 2011;91:542-8.
• 12. Wang ZJ, Zou CW, Li DC, Li HX, Wang AB, Yuan GD, et al. Surgical repair of sinus of valsalva aneurysm in asian patients. Ann Thorac Surg 2007;84:156-60.
• 13. Naka Y, Kadoba K, Ohtake S, Sawa Y, Hirata N, Nishimura M, et al. The long-term outcome of a surgical repair of sinus of valsalva aneurysm. Ann Thorac Surg 2000;70:727-9.