Ventriküler Septum Defekti Cerrahi Onarımında Mortaliteyi Etkileyen Erken Dönem Risk Faktörleri

Yıl 2008, Cilt: 25 Sayı: 3, 85 - 88, 29.12.2009

İsmail Kürşat Gökce Metin Sungur Pelin Ayyıldız Emine Azak Nazlıhan Günal Kemal Baysal

Öz

Bu çalışma, çocuklarda ventriküler septum defekti (VSD) cerrahi onarımında erken dönem mortaliteye etki eden faktörlerini belirlemeyi amaçlamaktadır. Bölümümüzde 20 yıl içerisinde VSD’si kapatılan 124 hasta retrospektif olarak değerlendirildi. Atriyal septum defekti (ASD) dışında eşlik eden kalp anomalisi olan hastalar çalışmaya alınmadı. Ortanca ameliyat yaşı 2.85 (0.25-17.5) yıl ve erken cerrahi mortalite 8 hasta ile %6,4 idi. Erken cerrahi kapatma yaşı, pulmoner-sistemik akımlar ve dirençler oranın yüksekliği, uzamış by-pass süresi ve ASD’in eşlik etmesinin mortalite için risk oluşturduğu görüldü. Sağ ventrikülotominin erken dönem mortaliteye etkisi yoktu.
Anahtar kelimeler: Ventriküler septum defekti, kalp cerrahisi, mortalite




Risk Factors Influencing Early Postoperative Mortality in Surgical Closure of Ventricular Septal Defects
In this study we aimed to determine the mortality risk factors of early period ventricular septal defect repairment in childhood. We retrospectively investigated 124 children with surgical closure treatment for ventricular septal defect in the last 20 years. Children with additional cardiac anomalies except ASD excluded from the study. Median age for surgery was 2.85 (0.25-17.5) years and early surgical mortality rate was 6,4% (8 patient). Early ages for surgical closure, high pulmonary-systemic flow and resistance rate, extended time for by-pass and have an additional cardiac anomaly like ASD were determined as the risk factors for mortality. Right ventriculotomy has no effect on the early mortality.

Anahtar Kelimeler

-

Kaynakça

• Tynan M, Anderson RH. Ventricular septal defect. In: Anderson RH, Baker EJ, Macartney FJ, Rigby ML, Shinebourne EA, Tynan M, editors. Paediatric Cardiology. Edinburgh: Churchill Livingstone, 2002. p. 983–1014.
• Jacobs JP, Burke RP, Quintessenza JA et al. Congenital Heart Surgery Nomenclature and Database Project: ventricular septal defect. Ann Thorac Surg 2000; 69: 25–35.
• Serraf A, Lacour-Gayet F, Bruniaux J, et al. Surgical management of isolated multiple ventricular septal defects. Logical approach in 130 cases. J Thorac Cardiovasc Surg 1992; 103: 437–443.
• Stark J, Gallivan S, Lovegrove J, et al. Mortalite rates after surgery for congenital heart defects in children and surgeons performance. Lancet 2000 (Mar) 18; 355 (9208): 1004–1007.
• Barratt-Boyes BG, Neutze JM, Clarkson PM, et al. Repair of ventricular septal defect in first to years of life using profound hypotermia-circulatory arrest techniques. Ann Surg 1976; 184: 376–390.
• Zhuang J, Zhang J, Cen J, et al. Surgical treatment of ventricular septal defect in infants: report of 230 cases. Zhonghua Wai Ke Za Zhi 1999 Apr; 37: 241–242.
• Erdoğan HB, Kırali K, Erentuğ V, ve ark. Ventriküler septal defekt onarımının geç dönem sonuçları ve risk analizi. Türk Göğüs Kalp Damar Cer Derg 2005; 13: 10–14.
• Afllamacı S, İkizler C, Yener A, ve ark. Ventriküler septal defekt cerrahisinde risk faktörleri. Hacettepe Tıp Dergisi 1986; 19: 151–157.
• Saleem K, Ahmad SA, Rashid A, et al. Outcome of ventricular septal defect closure. J Coll Physicians Surg Pak. 2004 Jun; 14: 351–364.
• Myhre U, Duncan DW, Mee RB, et al. Apical right ventriculotomy for closure of apical ventrikular septal defects Ann. Thorac Surg 2004 Jul 78 (1): 204–208.
• Mercan AS, Saygılı A, Sezgin A, Risk factors in infant ventricular septal defect surgery. Turkish J Thorac Cardiovasc Surg 2001; 9: 149–152.
• Knott-Craig CJ, Elkins RC, Ramakrishnan K et al. Associated atrial septal defects increase perioperative morbidity after ventricular septal defect repair in infancy. Ann Thorac Surg 1995; 59: 573–578.
• Ceviz M. Ventriküler septal defektlerde cerrahi tedavi ve operasyon sonuçları (Uzmanlık Tezi) 1991 İstan- bul. İstanbul ünv. Tıp Fakültesi.
• Demirağ MK, Keçeligil HT, Bahçıvan M, Baysal FK. Primer ventriküler septal defekt ve cerrahi onarımı. T Klin Kalp Dam Cer 2002; 3: 7–14.
• Roussin R, Serraf A, Bruniaux J, et al. Surgical treat- ment of isolated multiple ventricular septal defects. Arch Mal Coeur Vaiss 1996; 89: 571–577.