Parsiyel Pulmoner Venöz Dönüş Anomalisinin Cerrahi Onarımı Sonrası Orta ve Uzun Dönemde Aritmi ve Stenozun Değerlendirilmesi (Parsiyel Pulmoner Venöz Dönüş Anomalisinde Tek/Çift Yama ve Warden Operasyonlarının Karşılaştırılması): 2 Farklı Dönemin Karşılaştırmalı Çalışması

Öz

Çalışmamızda, Hacettepe Üniversitesi Tıp Fakültesi Kalp-Damar Cerrahisi Bölümü’nde, parsiyel pulmoner venöz dönüş anomalisi (PAPVD) tanısıyla tek yama- çift yama ve Warden prosedürü ile opere edilen 20 hasta (grup A) ve Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi’nde opere edilen 10 hasta ile Eskişehir Osmangazi Üniversitesi Tıp Fakültesi’nde opere edilen 62 hasta (grup B 72 hasta) retrospektif olarak incelendi. Farklı cerrahi tekniklerinin postoperative v. cava superior darlığı, pulmoner ven darlığı ve aritmi insidansı ile ilişkisi karşılaştırıldı. 2 farklı grup oluşturuldu: 2005-2011 yılları arasında, Hacettepe Üniversitesi Tıp Fakültesi’nde 20 hasta (A grubu) ve 2015-2022 yılları arasında Eskişehir Osmangazi Üniversitesi ile Muğla Sıtkı Koçman Üniversitesi Tıp Fakültesi’nde opere edilen toplam 72 hasta (B grubu). A grubunda 12 kız, 8 erkek hasta ortalama yaş sırasıyla 5.7±3 yıl (0.42-11yıl), ortalama ağırlık 18.67±9.01 kg (5.5-41 kg) idi. B grubunda 39 kız, 33 erkek hasta ise ortalama yaş 6.68±3.70 yıl (1-17 yıl), ortalama ağırlık 23.58±14.75 kg (8-80 kg) idi. Klinik, elektrokardiyogram ve ekokardiyografi incelemeleri derlendi. Erken ya da geç mortalite yoktu. Ortalama izlem süresi sırasıyla 39.73 ay ve 49.82 aydı. İzlemde pulmoner ven,v. cava superior stenozu gelişmedi. A grubunda, Warden prosedürü ve çift yama tekniği ile opere edilmiş birer hastaya rezidüel atrial septal defekt nedeniyle reoperasyon yapıldı. B grubunda ise reoperasyon yoktu. A grubundan 6 hastada, B grubunda da 4 hastada postoperative erken dönemde aritmi gelişti. Takipte tüm hastalar sinus ritmine geri döndü. Pacemaker hiçbir hastada gerekmedi. PAPVD farklı cerrahi tekniklerle güvenli olarak opere edilebilir. Tüm yöntemlerde sinus nodu (SN) hasarından kaçınmak için, çevresinde dikkatli doku diseksiyonu yapılmalıdır.

Anahtar Kelimeler

• Aritmi
• Obstrüksiyon
• Parsiyel Anormal Pulmoner Venöz Dönüş
• Stenoz

Determination of Stenosis and Arrhythmia After Surgical Operation of Partial Anomalous Pulmonary Venous Drainage in Mid & Longterm (Comparison of Double/Single Patch and Warden Operation in Partial Anomalous Pulmonary Venous Drainage): A Comparative Study of Two Different Time Intervals

Öz

We retrospectively investigated 20 patients who underwent partial anomalous pulmonary venous drainage (PAPVD) surgery with single-double patch, and Warden operation after surgical treatment in Hacettepe Medical School, department of cardiovascular surgery (group A) and 62 patients who underwent surgery with double patch in Eskişehir Osmangazi Medical School and 10 patients in Muğla Sıtkı Koçman Medical School (group B including 72 patients) at different time intervals. We compared postoperative v. cava superior stenosis, pulmonary vein stenosis and arrhythmia in regards of different techniques. We constituted 2 groups: 20 patients of Hacettepe Medical School between 2005-2011 (group A) and 72 patients of Muğla Sıtkı Koçman and Eskişehir Osmangazi Medical School between 2015-2022 (group B). Group A included 12 females, 8 males, the mean age was 5.7±3 years, ranging between 0.42 and 11 years, the mean weight was 18.67±9.01 kg, ranging between 5.50 and 41 kg. Group B included 39 females, 33 males, the mean age was 6.68±3.70 years, ranging between 1 and 17 years, mean weight was 23.58±14.75 kg, ranging between 8 and 80 kg. Clinical findings, electrocardiographic, echocardiographic evaluations were obtained. We found neither early nor late mortality in both groups. The mean follow-up duration were 39.73 months and 49.82 months respectively. No pulmonary venous or v. cava superior stenosis occurred in both groups. Reoperation for residual atrial septal defects required in 1 patient who underwent Warden procedure,1 patient who underwent double patch technique in group A. It didn’t require reoperation in group B. In group A, 6 patients presented rhythm disturbance in early postoperative period, as well as 4 patients in group B. In follow-up all patient recovered to sinus rhythm in both groups. Pacemaker wasn’t required. PAPVD can be safely operated using different procedures. Meticulous dissection nearby sinus node (SN) should be emphasized to avoid injury of SN for all techniques.

Anahtar Kelimeler

• Arrhythmia
• Obstruction
• Partial Anomalous Pulmonary Venous Return
• Stenosis

Kaynakça

1. 1. Campbell M. Natural history of atrial septal defect. Br Heart J. 1970;32(6):820-6.
2. 2. McCormack RJ, Pickering D, Smith II. A rare type of atrial septal defect. Thorax. 1968;23(4):350-2.
3. 3. Waqar T, Ansari ZA, Raza Baig MA. Outcome after surgical repair of partial anomalous pulmonary venous connection. Pak J Med Sci. 2016;32(6):1386-9.
4. 4. Warden HE, Gustafson RA, Tarnay TJ, et al. An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg. 1984;38(6):601-5.
5. 5. Gaynor JW, Burch M, Dollery C, et al. Repair of anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg. 1995;59(6):1471-5.
6. 6. Nicholson IA, Chard RB, Nunn GR, et al. Transcaval repair of the sinus venosus syndrome. J Thorac Cardiovasc Surg. 2000;119(4):741-4.
7. 7. Takahashi H, Oshima Y, Yoshida M, et al. Sinus node dysfunction after repair of partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg. 2008;136(2):329-34.
8. 8. Hu J, Hu R, Zhang H, et al. Midterm outcomes of surgical repair of partial anomalous pulmonary venous connection to SVC. Thorac Cardiovasc Surg. 2020;68(1):24-9.

9. 9. Okonta KE, Agarwal V. Does Warden's procedure reduce sinus node dysfunction after surgery for partial anomalous pulmonary venous connection? Interact Cardiovasc Thorac Surg. 2012;14(6):839-42.
10. 10. Valsangiacomo E, Schmid ER, Schüpbach RW, et al. Early postoperative arrhythmias after cardiac operation in children. Ann Thorac Surg. 2002;74(3):792-6.
11. 11. Lan YT, Lee JC, Wetzel G. Postoperative arrhythmia. Curr Opin Cardiol. 2003;18(2):73-8.
12. 12. Krongrad E. Postoperative arrhythmias in patients with congenital heart disease. Chest. 1984;85(1):107-13.
13. 13. Pfammatter JP, Bachmann DC, Wagner BP, et al. Early postoperative arrhythmias after open-heart procedures in children with congenital heart disease. Pediatr Crit Care Med. 2001;2(3):217-22.
14. 14. Skippen PW, Sanatani S, Gow RM, et al. Diagnosis of postoperative arrhythmias following paediatric cardiac surgery. Anaesth Intensive Care. 2009;37(5):705-19.
15. 15. Alsoufi B, Cai S, Van Arsdell GS, et al. Outcomes after surgical treatment of children with partial anomalous pulmonary venous connection. Ann Thorac Surg. 2007;84(6):2020-6.
16. 16. Iyer AP, Somanrema K, Pathak S, et al. Comparative study of single- and double-patch techniques for sinus venosus atrial septal defect with partial anomalous pulmonary venous connection. J Thorac Cardiovasc Surg. 2007;133(3):656-9.
17. 17. Yong MS, Griffiths S, Robertson T, et al. Outcomes of the Warden procedure for partial anomalous pulmonary venous drainage in children. Interact Cardiovasc Thorac Surg. 2018;27(3):422-6.
18. 18. Agarwal V, Okonta KE, Abubakar U, et al. Impact of Warden's procedure on the sinus rhythm: our experience. Heart Lung Circ. 2011;20(11):718-21.
19. 19. Baron O, Roussel JC, Videcoq M, et al. Partial anomalous pulmonary venous connection: correction by intra-atrial baffle and cavo-atrial anastomosis. J Card Surg. 2002;17(2):166-9.
20. 20. Ohmi M, Mohri H. A single pericardial patch technique for repair of partial anomalous pulmonary venous drainage associated with sinus venosus atrial septal defect. Ann Thorac Surg. 1988;46(3):360-1.
21. 21. Buz S, Alexi-Meskishvili V, Villavicencio-Lorini F, et al. Analysis of arrhythmias after correction of partial anomalous pulmonary venous connection. Ann Thorac Surg. 2009;87(2):580-3.
22. 22. Jaschinski C, Cussigh C, Fonseca E, et al. A wide comparison of techniques for repair of PAPVCs: one institution’s 20-year experience. Thorac Cardiovasc Surg. 2020;68(1):15-23.
23. 23. Trusler GA, Kazenelson G, Freedom RM, et al. Late results following repair of partial anomalous pulmonary venous connection with sinus venosus atrial septal defect. J Thorac Cardiovasc Surg. 1980;79(5):776-81.
24. 24. Nakahira A, Yagihara T, Kagisaki K, et al. Partial anomalous pulmonary venous connection to the superior vena cava. Ann Thorac Surg. 2006;82(3):978-82.
25. 25. Chaiyarak K, Soongswang J, Durongpisitkul K, et al. Arrhythmia in early post cardiac surgery in pediatrics: Siriraj experience. J Med Assoc Thai. 2008;91(4):507-14.
26. 26. Öztürk E, Kafalı HC, Tanıdır İC, et al. Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2021;29(1):27-35.
27. 27. Rekawek J, Kansy A, Miszczak-Knecht M, et al. Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period. J Thorac Cardiovasc Surg. 2007;133(4):900-4.