Resection End To End Anastomosis, Subclavian Flap Aortoplasty And Modifed Subclavian Aortoplasty Surgical Techniques of the Aortic Coarctation Compared by The Insidancy Of Recoartation

Yıl 2010, Cilt: 13 Sayı: 3, 14 - 20, 01.03.2009

Ahmet Şaşmazel Tufan Paker Atıf Akçevin Halil Türko¤lu Tayyar Sar›o¤lu Ayd›n Aytaç

Öz

Resection End To End Anastomosis, Subclavian Flap Aortoplasty And Modifed Subclavian Aortoplasty Surgical Techniques of the Aortic Coarctation Compared by The Insidancy Of Recoartation We try to evaluate the incidence of recoarctation after the surgical repair techniques for aortic coarctation in two group of patients ages between 0-3 months and 3–24 months. These techniques are resection end to end anastomosis, subclavian flap aortoplasty and modified subclavian aortoplasty. We aim to figure out which operation appears to have a clear superiority according to the age groups. From June, 1987, to December, 1999, a consecutive series of 72 patients less than 2 year of age were referred to our clinic for aortic coarctation repair. Patients diveded into two groups by means of their ages. The group 1; ages were between 0–3 months, group 2; ages were between 3–24 months old. The surgical techniques were resection end to end anastomosis, subclavian flap aortoplasty and modified subclavian aortoplasty. The patients were evaluated according to their ages, coarctation gradient and reoperations depending on the surgical techniques that was done before.We lost 4 patient in group 1 at the early period of the operations. These patients had severe congestive heart failure and complex cardiac pathologies prior to the operations Recoarctation was occurred in 4 patients in group 1. 3 of these patient had subclavian flap aortoplasty and one had resection end to end anastomosis before. All 3 recoarctation cases were successfully treated by surgery. One patient had a balloon angioplasty. Recoarctation occurred in 1 patient in group 2 ( below the age 24 months). This patient operated by the surgical technique of resection end to end anastomosis and thereafter successfully treated by balloon angioplasty. According to our surgical experiences resection end to end anastomosis can be safely performed below the age of 3 months. For surgical necessities subclavian flap aortoplasty and modified subclavian aortoplasty are admirable for relief of the coarctation in infants with low recurrence rates and acceptable operative and intermediate survival. But the subclavian flap should be extended distally over the coarctated segment.

Anahtar Kelimeler

Aortic coartation, surgical techniques, recoarctation

Aort Koarktasyonu Tamirinde, Rezeksiyon Uç Uca Anastomoz, Subklavyan Flap Aortoplasti ve Modifiye Subklavyan Aortoplasti Cerrahi Tekniklerinin Rekoarktasyon Açısından Karşılaştırılması

Öz

Bu yazmzda, 0–3 ay ve 3–24 ay arasndaki aort koarktasyonlu hasta gruplarnda, rezeksiyon uçuca anastomoz, subklavyan flap aortoplasti ve modifiye subklavyan aortoplasti tekniklerinin geç postoperatif dönemde rekoarktasyon yönünden birbirleriyle karfllafltrmak ve hangi prosedürün yafl gurubuna göre daha uygun oldu¤unu belirlemeyi amaçladk. Haziran 1987 - Aralk 1999 tarihleri arasnda aort koarktasyonu tans nedeniyle opere edilen, 2 yafl altnda toplam 77 hasta çalflmaya alnd. Hastalar iki grupta topland. Grup 1, 0–3 ay aras olup, grup 2 ise 3–24 ay aras opere edilen hastalar idi. Cerrahi prosedür olarak, rezeksiyon uç uca anastomoz, subklavian flap aortoplasti ve modifiye subklavyan aortoplasti teknikleri kullanld. Uygulanan cerrahi tekni¤ine göre hastalar yafl, postoperatif dönemde koarktasyon bölgesinden elde edilen basnç gradiyentlerine, reoperasyona göre karfllafltrld. Grup 1'de, 4 hastamz postoperatif dönemde kaybettik. Bu hastalarn preoperatif dönemde ileri derece kalp yetersizli¤ i bulgular ve kompleks kalp patolojileri olan hastalard. Grup'1 de, 4(%12) hastada rekoarktasyon görüldü. 3 hastaya subklavyan flap angioplasti 1 hastaya da, reseksiyon uç uca anastomoz cerrahi teknikleri uygulanmflt. 3 hasta rekoarktasyon nedeniyle ameliyata alnd. 1 hastann ise koarktasyonu balon anjioplasti ile geniflletildi. Grup 2'de mortaliteye rastlanmad. Fakat ancak Grup 2'de reseksiyon uç uca anastomoz sonras 1 hastada rekoarktasyon görüldü ve balon anjioplasti ile geniflletildi. Çalflmamzn sonucuna göre 3 ay alt çocuklarda reseksiyon uç uca anastomoz tekni¤i güvenilir bir cerrahi prosedürdür. Cerrahi yönden gerekli oldu¤u durumlarda e¤er subklavyan flap veya modifiye subklavyan aortoplasti tekni¤ i kullanlacaksa flap mümkün oldu¤unca kaorkte segmentin distaline kadar uzatlmaldr.

Anahtar Kelimeler

Aort koarktasyonu, cerrahi teknikler, rekoarktasyon

Kaynakça

• Castañeda A.R., Jonas R.A., Mayer J.J., Hanley F.Aortic Coarctation. In: Castañeda A., Jonas R., Mayer J.J., Hanley F., eds. Cardiac surgery of the neonate and infant. Philadelp- hia: WB Saunders Co, 1994:333-52.
• Kirklin J.W., Barratt-Boyes B.G. Coarctation of the aorta and interrupted aortic arch. In: Kirklin J.W., Barratt-Boyes B.G., eds. Cardiac surgery, 2nd ed. New York: Churchill Li- vingston, Inc, 1993:1263-326
• WH Merrill, SJ Hoff, JR Stewart, CC Elkins, TP Graham Jr and HW Bender Jr Operative risk factors and durability of re- pair of coarctation of the aorta in the neonate; The Annals of Thoracic Surgery, Vol 58, 399-402
• Crafoord C, Nylin G. Congenital coarctation of the aorta and its surgical treatment. J Thorasic Surgery1945;14:347-61.
• Waldhausen JA, Nahrwold DL. Repair of coarctation of the aorta with a subclavian flap. J. Thorac. Cardiovasc. Surg ;51:532-3
• Sariolu T, Süzer K, Akçevin A et al. A new surgical techni- que for repair of aortic coarctation.Vascular Surgery ;26:103-8
• GA Russell, PJ Berry, K Watterson, JP Dhasmana and JD Wisheart; Patterns of ductal tissue in coarctation of the aor- ta in the first three months of life: The Journal of Thoracic and Cardiovascular Surgery 1991 Vol 102, 596-601, Cop- yright
• Elzenga NJ; Locolized coarctation of the aorta an age de- pendent spectrum. Br. Heart J.1983,49:317-23 P Değeri Hasta sayısı