Postoperatif Fallot Tetralojili Çocuklarda Kısa ve Orta Dönem Sonuçlarımızın Değerlendirilmesi

Öz

Amaç: Tam düzeltme ameliyatı yapılmış Fallot tetralojili hastalarımızın klinik durumlarının değerlendirilmesi, ritim bozukluklarının araştırılması, ekokardiyografi ile ventrikül fonksiyonlarının ve aort kökü dilatasyonunun değerlendirilmesidir.

Gereç ve Yöntemler: İstanbul Üniversitesi, İstanbul Tıp Fakültesi Çocuk Kardiyoloji bölümünde izlenen, düzeltme operasyonu uygulanmış Fallot tetralojili 50 çocuk çalışmaya dahil edildi. Düzeltilmiş Fallot tetralojili olgular aort kökü dilate olanlar ve dilate olmayanlar diye iki guruba ayrıldı. Her iki gurup arasında cinsiyet, tam düzeltme operasyonu yaşı, aort yetersizliği, triküspit yetersizliği, pulmoner yetersizlik, palyatif tedavi ve transanüler yama kullanımı açısından farklar değerlendirildi. Pulmoner kapak yetmezliği, tam düzeltme ameliyatı sırasında uygulanan transanüler yama yapılanlar ve yapılmayanlar olarak karşılaştırıldı. Düzeltilmiş Fallot tetralojili olguların ekokardiyografik olarak ölçülen aort kökü ve asendan aort çapları yaş, cinsiyet ve vücut yüzey alanlarına göre normal dağılımları ile değerlendirildi.

Bulgular: Çalışmaya 24 Ocak-15 Mayıs 2014 tarihleri arasında 50 olgu alındı. Çalışmaya katılan olguların yaşları 2-21 yıl arasında değişmekte olup, ortalama 9.9 ±4.5 yıldır. Çalışmaya katılanların %52’si (n=26) erkek, %48’i (n=24) kızdır. Olguların total düzeltme yaşları 6 (0.5 yıl) ile 190 (15.8 yıl) ay arasında değişmekte olup, ortalama 28.3 ± 28.3 (2.3 ± 2.3 yıl) aydır. Postoperatif süreleri 1.3-17.8 yıl arasında değişmekte olup, ortalama 8.0 ± 4.1 yıldır. Olguların %28’ine (n=14) palyatif tedavi uygulanmıştır. Olguların aort kök ölçümleri 18.0 ile 42.5 mm arasında değişmekte olup, ortalama 27.9 ±5.3 mm’dir. Olguların %12’sinin (n=6) aort kökü dilatasyonu yok iken, %88’inin (n=44) aort kökü dilatasyonu vardır. Olguların tamamında (%100) sağ ventrikül dilatasyonu ve asendan aort dilatasyonu vardır. Transanüler yama uygulananlarda, orta ve ağır pulmoner yetmezlik daha az saptandı (p: 0.02). Sonuç: Olguların %88’inde (n: 44) aort kökü dilatasyonu saptandı. Yıllık aort kökü çapı ölçümlerinin verilmesi, Fallot tetralojili hastalarda ilerleyici aort kökü dilatasyonunun tedavisinde daha etkili bir stratejisinin planlanmasına yardımcı olacaktır.

Anahtar Kelimeler

• Fallot Tetralojisi
• Aort Kökü Dilatasyonu
• Tam düzeltme ameliyatı

Evaluation of Short and Mid-term Outcomes in Children with Postoperative Fallot Tetralogy

Öz

Objective: This study aims to evaluate clinic situations, investigate arrhythmias, and assess ventricle function by echocardiography and aortic root dilation of patients with Tetralogy of Fallot who had undergone total correction surgery.

Material and Methods: 50 children with Tetralogy of Fallot and who had undergone a total correction operation in I.U. Faculty of Medicine Pediatric Cardiology Department were included to study. Corrected Tetralogy of Fallot cases were divided into two main groups as “aortic root dilated group” and “aortic root not-dilated group”. Groups were evaluated as to their gender, age of correction surgery, presence of aortic failure, tricuspid failure, pulmonary failure, aorta pulmonary shunt treatment and usage of transannular patch. Pulmonary valve failure was compared as those with and without transannular patches applied during the total correction surgery. Echocardiographically measured aortic root and ascending aorta diameters were assessed according to age, gender, and body surface area of the corrected Fallot Tetralogy cases.

Results: 50 subjects were involved to study in date between 24th Jan. 2014 and 15th May 2014. Age of the cases in study varied between 2 and 21 years and average age was 9.9 ± 4.5 years. 52% (n=26) of them are male and 48% are female (n=24). Total correction age was varied between 6 months (0.5 years) and 190 months (15.8 years) and average age was 28.3±28.3 months (2.3 ±2.3 years). Their postoperative periods were varied between 1.3 and 17.8 years and average period was 8.0±4.1 years. 28% (n=14) of the cases were received palliative treatment. Aortic root size was varied between 18 and 42.5 and average size was measured as 27.9±5.3 mm. Aortic root dilation ratio of the cases was 88% (n=44) while 12% of cases (n=6) had no aort root dilatation. All patients had right ventricle and ascending aorta dilation. Moderate and severe pulmonary failure was found less in those who underwent transannular patch.

Conclusion: Aortic root dilation was detected in 88% (n=44) of the cases. Providing annual aortic root diameter measurements will help to plan a more effective strategy for the treatment of progressive aortic root dilatation in patients with Fallot tetralogy.

Anahtar Kelimeler

• Tetralogy of Fallot
• Total Correction Operation
• Aortic Root Dilatation

Kaynakça

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