Early and Mid-term Results of Patients Who Underwent Surgical Repair of Ventricular Septal Defect After The Infantile Period

Yıl 2020, Cilt: 23 Sayı: 1, 9 - 14, 01.04.2020

Servet Ergün Mustafa Güneş Zeynep Kük Erkut Öztürk İsmihan Onan Alper Güzeltaş Sertaç Haydin

Öz

Introduction: The purpose of this study is to evaluate the mortality, morbidity, postoperative course, and mid-term complications of patients who underwent surgical repair of ventricular septal defect (VSD) after the infantile period.

Patients and Methods: We retrospectively reviewed 80 patients, older than 1 year, who were operated in our center between 2014 and 2018. We defined “prolonged” as the condition in which the mechanical ventilation was more than 24 hours, ICU stay was longer than 3 days, and hospital stay was longer than 7 days. We considered cardiopulmonary resuscitation, need for extracorporeal membrane oxygenator, complete atrioventricular block requiring permanent pacemaker (PM) implantation, diaphragm paralysis, neurological complications, acute renal failure, and unplanned reoperation as the major adverse events (MAE).

Results: The median age of patients was 3 (1.5-20) years. There were 31 (38.8%) female patients in our study. The median operation weight was 12.3 kg (8-60). Indications for operations were pulmonary hypertension (PH) in 30 (37.5%) patients, aortic regurgitation and aortic valve prolapse in 30 (37.5%) patients, and left ventricular (LV) dilatation in 20 (25%) patients. We did not observe mortality in any of the cases. We observed MAE only in one patient (1.3%) (PM implantation). The mean follow-up period was 2.9 ± 1.9 years. Pulmonary arterial pressure decreased significantly after surgery (20% vs. 0% of patients with severe PH, p < 0.001). Left ventricular end-diastolic diameters (LVEDDs) were significantly decreased after operation, and this condition persisted in the mid-term follow-ups (LVEDD: 36.9 ± 9.7 vs. 33.0 ± 6.6, p= 0.02).

Conclusion: Patients with VSD who are awaiting spontaneous closure after the infantile age are highly recommended to undergo rigorous follow-ups. A meticulous examination of patients with late onset VSD preoperatively with a prompt referral to surgery will maintain satisfactory outcomes in early and late mortality and morbidity rates.

Anahtar Kelimeler

Ventricular septal defect, long term, mortality, morbidity

İnfantil Dönem Sonrası Cerrahi Tamir Yapılan Ventriküler Septal Defektli Hastaların Erken ve Orta Dönem Sonuçları

Öz

Giriş: Bu çalışmada infantil dönem sonrası opere edilen ventriküler septal defekt hastalarının mortalite, morbidite gelişimi, postoperatif seyir ve orta dönem komplikasyon açısından değerlendirilmesi amaçlandı.

Hastalar ve Yöntem: Merkezimizde 2014-2018 yılları arasında ventriküler septal defekt (VSD) tanısı ile opere edilmiş bir yaş üstü 80 hasta retrospektif olarak incelendi. Uzamış mekanik ventilasyon > 24 saat, uzamış yoğun bakım > 3 gün, uzamış hastane kalışı ise > 7 gün olarak kabul edildi. İstenmeyen yeniden operasyon, kalıcı bir kalp pilini gerektiren kalp bloğu, mekanik destek ihtiyacı, nörolojik defisit, diyafram paralizisi ve ani dolaşım durması majör advers olay olarak kabul edildi.

Bulgular: Ortanca yaş 3 (1.5-20) yıl idi. Hastaların 31 (%38.8)’i kız idi. Ortanca operasyon kilosu 12.3 kg (8-60) idi. Operasyon endikasyonu 30 (%37.5) hastada pulmoner hipertansiyon, 30 (%37.5) hastada aort kapak yetmezliği ve prolapsusu, 20 (%25) hastada ise sol ventrikül genişlemesi olarak saptanmıştır. Operasyona bağlı mortalite gözlenmemiştir. Majör advers olay bir hastada (pacemaker implantasyonu) (%1.3) gözlenmiştir. Hastaların ortalama takip süresi 2.9 ± 1.9 yıl saptanmıştır. Takipte pulmoner arter basınç düzeyi operasyon sonrası dönemde operasyon öncesi döneme göre anlamlı düşmüştür (ileri PHT’li hasta sayısı %20 vs. %0, p< 0.001). Operasyon sonrası erken dönemde sol ventrikül sonu diyastolik çaplarında belirgin azalma gözlendiği ve bu durumun orta dönemde de devam ettiği görülmüştür (36.9 ± 9.7 vs. 33.0 ± 6.6, p= 0.02).

Sonuç: İnfantil dönem sonrası VSD tanılı olgularda spontan kapanmanın beklendiği hastaların takiplerinin titizlikle yapılması ve geç başvuran hastaların preoperatif ayrıntılı şekilde değerlendirilmesi ve cerrahi tamire uygun hastaların bekletilmeden opere edilmesi erken ve uzun dönem mortalite ve morbiditeye olumlu katkı sağlayacaktır.

Anahtar Kelimeler

Ventriküler septal defekt, mortalite, majör advers olay, morbidite, uzun dönem

Kaynakça

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