Posteriyor mitral liflet prolapsusunun Fundaro anüloplasti ile onarımı: Sütür anüloplasti teknikleri cerraha yardımcı olabilir mi?

Öz

Amaç Fundaro anuloplasti, inferior miyokard enfarktüsü nedeniyle oluşan mitral yetmezlikte lifletlerin asimetrik bağlanması için geliştirilmiş bir posteriyor liflet onarım tekniğidir. Çalışmamızda fundaro anuloplasti tekniğinin operatif ve orta dönem sonuçlarımızı paylaşmayı amaçladık. Gereç ve Yöntemler Tip 3b mitral yetersizliği nedeniyle Fundaro anuloplasti uygulanan 30 hasta çalışmaya dahil edildi. Bu hasta grubundan 20 hastaya KABG ile birlikte Fundaro anuloplasti uygulandı, geri kalan 10 hastaya kombine işlemler uygulandı. Hastaların takiplerinde fizik muayene, elektrokardiyografi ve transtorasik ekokardiyografi yapıldı. Bulgular Çalışmaya alınan hastaların ortalama takip süresi 35,8±20,3 aydı (min:1 max:59). İntraoperatif yapılan TEE verilerine göre 24 (%80) hastada MY saptanmadı. Hastaların ameliyat sonrası ortalama takip süresi 35,8±20,3 aydı. İzlemde 23 (%76,7) hastada tekrarlayan MY izlenmedi. Postoperatif erken dönemde 2 (%6,7) hastada mortalite gelişti. Fonksiyonel kapasitelerinde anlamlı iyileşme gözlendi(p<0.001). Ortalama sol ventrikül diyastol sonu çapı, sol ventrikül sistol sonu çapı, sol atriyum çapı ve pulmoner arter basıncındaki düzelmeler ameliyat öncesi değerlere göre istatistiksel olarak anlamlı bulundu (p=0,001, p=0,001, p=0,007 ve p) = 0.001, sırasıyla). Sonuç Fundaro anuloplasti daha kısa XCL süresinde yapılabilmesi nedeniyle avantajlıdır. İskemiye bağlı mitral kapak yetmezliği olan hastalarda bu teknik ile onarım sonrası düşük nüks oranı ve ventriküler yeniden şekillenme üzerinde olumlu etkiler elde edilebilmektedir.

Anahtar Kelimeler

• mitral kapak
• iskemik kalp hastalığı
• fundaro anüloplasti

Correction of posterior mitral leaflet prolapse with Fundaro annuloplasty: Can suture annuloplasty techniques be helpful for surgeon?

Öz

Aim Fundaro annuloplasty is a posterior leaflet repair technique developed for asymmetric tethering of mitral leaflets due to inferior myocardial infarction. ". In our study, we aimed to share our the operative and mid-term results of the fundaro annuloplasty technique. Material and Methods 30 patients who underwent Fundaro annuloplasty for type 3b mitral regurgitation were included in the study. Fundaro annuloplasty with CABG was performed in 20 patients from this patient group, the remaining 10 patients underwent combined procedures. During the flollow-ups of the patients, physical examination, electrocardiography and transthoracic echocardiography were performed. Results The mean follow-up period of the patients included in the study was 35.8±20.3 months (min:1 max:59). According to the TEE datas performed intraoperatively, MR was not detected in 24 (80%) patients. The mean postoperative follow-up period of the patients was 35.8±20.3 months. During the follow-up period, recurrent MR was not observed in 23 (76.7%) patients. Mortality developed in 2 (6.7%) patients in the early postoperative period. Significant improvement was observed in their functional capacities(p<0.001). Improvements in mean left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left atrial diameter, and pulmonary artery pressure were found to be statistically significant when compared with preoperative values (p=0.001, p=0.001, p=0.007 and p=0.001, respectively). Conclusion Fundaro annuloplasty is an advantageous because it can be performed in shorter XCL time. Low recurrence rate after repair and positive effects on ventricular remodeling can be achieved with this technique in patient with mitral valve insufficiency due to ischemia.

Anahtar Kelimeler

• mitral valve
• ischemic heart disease
• fundaro annuloplasty

Kaynakça

1. 1. Dr. Mustafa PAÇ ve arkadaşları. Kalp ve Damar Cerrahisi. 2004. Edinsel Mitral Kapak Hastalıkları: 487-88,507-08
2. 2. Dr. Enver DURAN. Kalp ve Damar cerrahisi.2004. cilt 2. Kombine Kapak ve İskemik Kalp Hastalığı.1235-44
3. 3. Lawrence H.Cohn, L.Henry Edmunds,Jr. Cardiac Surgery In The Adult 2003, Pathophysiology of Mitral Valve Disease:903- 27,Valvuler and Ischemic Heart Disease: 1058-74
4. 4. Fundarò P, Pocar M, Moneta A, Donatelli F, Grossi A, Posterior mitral valve restoration for ischemic regurgitation. Ann Thorac Surg, 2004 Feb;77(2):729-30.
5. 5. LungB. Management of ischaemic mitral regurgitation. Heart 2003;89:459-464.
6. 6. Agnieszka Ciarka, MD, PhDa, Jerry Braun, MDb, Victoria Delgado, MDa, Michel Versteegh, MD, PhDb, Eric Boersma, MSc, PhDc, Robert Klautz, MD, PhDb, Robert Dion, MD, PhDb, Jeroen J. Bax, MD, PhDa,*, andNicoVandeVeire,MD,PhDa. PredictorsofMitralRegurgitation Recurrence in Patients With Heart Failure Undergoing Mitral Valve Annuloplasty. Am J Cardiol 2010;106:395– 401)
7. 7. Kumanohoso T, Otsuji Y, Yoshifuku S, et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J.Thorac Cardiovasc Surg 2003;125:135–43.
8. 8. Miller DC. Ischemic mitral regurgitation redux—To repair or to replace? J Thorac Cardiovasc Surg 2001;122:1059–62.

9. 9. Filsoufi F, Flores KQ, Chen RH, Cohn LH, Nathan NS, Byrne JG et al. Does coronary artery bypass grafting alone correct moderate ischaemic mitral regurgitation? Circulation 2001;104:I68- I75.
10. 10. Kim YH, Czer LS, Soukiasian HJ, De Robertis M, Magliato KE, Blanche C et al. Ischemic mitral regurgitation: revascularization alone versus revascularization and mitral valve repair Ann Thorac Surg 2005;79:1895-1901.
11. 11. Adem İ Diken, MD,1 Garip Altınta, MD,2 Adnan Yalçınkaya, MD,1 Gökhan Lafçı, MD,2 Onur Hanedan, MD,2 Kerim Çağlı, MD2 Surgical Strategy for Moderate Ischemic Mitral Valve Regurgitation: Repair or Ignore? The Heart Surgery Forum #2014-337 17 (4), 2014
12. 12. Langer, F., Borger, M. A., Czesla, M., Shannon, F. L., Sakwa, M., Doll, N.,... & Schäfers, H. J. (2013). Dynamic annuloplasty for mitral regurgitation. The Journal of Thoracic and Cardiovascular Surgery, 145(2), 425-429. MOLA et al. Correction of posterior prolapse with Fundaro annuloplasty
13. 13. A. Marc Gillinov, MDa Per Nils Wierup, MDa* Eugene H. Blackstone, MDa,b. Is repair preferable to replacement for ischemic mitral regurgitation? A. Marc Gillinov, MDa Per Nils Wierup, MDa* Eugene H. Blackstone, MDa,b. The Journal of Thoracic and Cardiovascular Surgery • Volume 122, Number 6 1125
14. 14. Duk-Hyun Kang, Mi-Jeong Kim, Soo-Jin Kang, Jong-Min Song, Hyun Song, Myeong-Ki Hong. Mitral Valve Repair Versus Revascularization Alone in the Treatment of Ischemic Mitral. Circulation. 2006;114:I-499-I-503