Aortic Valve Replacement with A Prosthetic Valve with A High Effective Orifice Area in Congenital Aortic Valve Diseases: Our Early Results

Öz

Objective: In this study, we aimed to share the early results of aortic valve replacement using a prosthetic valve with a high effective orifice area in selected patients with congenital aortic valve disease.
Material and Methods: Between August 2019 and August 2020, a total of 4 pediatric patients underwent aortic valve replacement with a mechanical prosthetic valve. Patient data was analyzed retrospectively. All of the patients were male and their ages were between 10 and 14 years. Three patients had congenital aortic stenosis and one patient had moderate aortic regurgitation after balloon valvuloplasty due to aortic stenosis. After median sternotomy, aortic valve replacement was performed using a 16 mm highly effective orifice area mechanical prosthetic valve in all patients. In 3 patients, aortic root enlargement was performed by Manuqian technique due to the narrow aortic annulus.
Results: No postoperative rhythm problem was observed in any patient. No surgical exploration was required due to bleeding or tamponade. The patients were taken to the service after receiving intensive care treatment for 42 (36-48) hours. They were discharged from the hospital in 6.5 (6-8) days. Mortality was not observed in any patient. The prosthetic valves were observed to be functioning normally in the postoperative early period, 1st month and 6th month control echocardiographies and no pathological gradient was detected. There were no thromboembolic or hemorrhagic complications.
Conclusion: We think that aortic valve replacement performed with a prosthetic valve with a high effective orifice area in selected patients with congenital aortic valve disease can be a good alternative treatment method according to the early results in this study. There is a need for studies with more patients and longer-term follow-up results.

Anahtar Kelimeler

• Congenital heart surgery
• mechanical prosthetic valve
• aortic valve replacement

KONJENİTAL AORT KAPAK HASTALIKLARINDA YÜKSEK EFEKTİF AÇIKLIK ALANLI PROTEZ KAPAK İLE YAPILAN AORT KAPAK REPLASMANI: ERKEN DÖNEM SONUÇLARIMIZ

Öz

Amaç: Bu çalışmada konjenital aort kapak hastalığı olan seçilmiş hastalarda yüksek efektif açıklık alanlı protez kapak kullanılarak yapılan aort kapak replasmanı erken dönem sonuçlarını paylaşmayı amaçladık.

Gereç ve Yöntemler: Ağustos 2019-Ağustos 2020 tarihleri arasında toplam 4 pediatrik hastaya mekanik protez kapakla aort kapak replasmanı gerçekleştirildi. Hasta bilgileri retrospektif olarak incelendi. Hastaların tamamı erkekti ve yaşları 10-14 yıl arasındaydı. Üç hastada konjenital aort stenozu vardı ve bir hastada aort stenozu nedeniyle yapılan balon valvuloplasti sonrası orta derece aort yetmezliği olduğu saptandı. Hastaların tamamına median sternotomi ile 16 mm yüksek efektif açıklık alanlı mekanik protez kapak kullanılarak aort kapak replasmanı yapıldı. Üç hastada aortik anulusun dar olması sebebiyle Manuqian tekniği ile aort kök genişletmesi uygulandı.

Bulgular: Postoperatif dönemde hiçbir hastada ritim problemi olmadı. Kanama veya tamponad nedeniyle eksplorasyon gerekmedi. Hastalar 42 (36-48) saat yoğun bakım tedavisi gördükten sonra servise alındı. Hastaneden 6.5 (6-8) günde taburcu oldular. Hiçbir hastada mortalite gelişmedi. Postoperatif erken dönemde, 1. ay ve 6. aylardaki kontrol ekokardiyografilerinde protez kapakların fonksiyonları normaldi ve patolojik bir gradient saptanmadı. Tromboembolik ve hemorajik bir komplikasyon görülmedi.

Sonuç: Bu çalışmada, konjenital aort kapak hastalığı olan seçilmiş hastalarda yüksek efektif açıklık alanlı protez kapakla yapılan aort kapak replasmanının erken dönem sonuçlarına göre iyi bir alternatif tedavi yöntemi olabileceğini düşünüyoruz. Daha çok hasta üzerinde ve daha uzun dönem takip sonuçlarını içeren çalışmalara gerek vardır.

Anahtar Kelimeler

• Konjenital kalp cerrahisi
• mekanik protez kapak
• aort kapak replasmanı

Kaynakça

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