Yenidoğan izole konjenital kalp bloklarında pacemaker implantasyonu: Tek merkez deneyimi

Yıl 2018, Cilt: 9 Sayı: 3, 227 - 232, 30.09.2018

Murat Koç

https://doi.org/10.18663/tjcl.454171

Öz

Amaç: Yenidoğan döneminde izole
konjenital tam kalp bloğu oldukça nadir görülen bir hastalıktır. Genellikle
anne kanında altta yatan immun sistem hastalıklarına bağlı gelişen

otoantikorların
plasenta yoluyla geçişi ile bebeğin kalp ileti sisteminde fibrozis ile
sonuçlanmasının neden olduğu bilinmektedir. 
Erken dönemde tanı konulmayan ve tedavi edilmeyen hastalarda yüksek
oranda ani bebek ölümü ve ciddi morbidite ile kendini gösterir. Bu çalışmadaki
amacımız kliniğimizin konu ile ilgili tecrübelerini aktarmaktır.

Gereç ve Yöntemler: Çalışmada 2011-2017
yılları arasında Dr. Sami Ulus Kadın Doğum Çocuk Sağlığı ve Hastalıkları Eğitim
ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniğinde izole kalp bloğu
nedeniyle cerrahi olarak epikardiyal kalp pili implante edilen 9 hasta (1 erkek,
8 kız) retrospektif olarak incelendi. 

Bulgular: Altı hastada (%67) kalp bloğu
tanısı intrauterin hayatta iken yapılan fetal ekokardiyografi incelemesi ile
kondu. 3 (%33) hastamızda ise doğumdan sonra ortaya çıkan bradikardi sonrası
çekilen elektrokardiyografiler (EKG) ve transtorasik ekokardiyografi( TTE)
incelemeleri ile tanı konuldu. Hastaların 8 (%89)’inde annede otoimmün bir
hastalık bulunmaktaydı. Bunların %62’si Sistemik Lupus Eritamatozus (SLE)
(n=5), %38’i Sjögren Sendromu (n=3) tanıları ile takip edilmekteydi. Tüm
hastalara epikardiyal kalp pili implante edildi. Bir hastada postoperatif 2.
ayda sepsis nedeniyle mortalite görüldü. Diğer hastaların takipleri sorunsuz
olarak devam etmektedir.

Sonuç: Yenidoğan dönemi tam kalp bloğu
yüksek mortalite ve morbidite ile seyreden bir durumdur. Artan tecrübe ile birlikte
fetal ekokardiyografi prenatal dönemde birçok konjenital kalp hastalığının
tanısının konulmasını sağlamaktadır. Epikardiyal kalp pili implantasyonu
mortalite ve morbiditede belirgin derecede azalma sağlayan tek tedavi
yöntemidir.

 

Anahtar Kelimeler

yenidoğan, kalp bloğu, kalp pili

Pacemaker implantation in newborn isolated congenital heart blocks: A single center experience

Öz

Aim: isolated congenital complete heart
block in the neonatal period is a very rare disease. Generally, fibrosis in the
conduction system of newborn caused by antibodies of mother with autoimmune
disease is responsible for this complete heart block. This situation is related
with high risk of sudden infant death and serious morbidities in undiagnosed
and untreated newborns. In this study we aim to share our experience about
these patients.

Material and Methods: 9 patients (1
male and 8 female) whom implanted epicardial pacemaker due to isolated complete
heart block were retrospectively evaluated in Dr. Sami Ulus Maternity and Child Health Research and Training Hospital
Cardiovascular Surgery clinic between 2011-2017were evaluated
retrospectively in this study.

Results:  Disease was diagnosed in 6 (67%) patients
during  intrauterine period with fetal
echocardiography and in 3 (33%) patients diagnosis was achieved with
electrocardiograpy and transthroacic echocardiography after bradycardia was
seen. There were autoimmune disorders in mothers of 8 (89%) infants. 62% of
them were already had Systemic Lupus Erythematosus (SLE) (n=5) and 38% of them
had sjören's syndrome (n= 3). Epicardial pacemaker implantation was performed
in all of our patients. One postoperative mortality was seen due to sepsis at
2nd month. Other patients' early and midterm follow-ups have been favorable.

Conclusion: Isolated heart
block in newborn has high mortality and morbidity rates. After improvements in
technology fetal echocardiography  can
help us to diagnose a lot of congenital heart disease. Epicardial pacemaker
implantation is the only treatment option which can decrease mortality and
morbidity rates.

Anahtar Kelimeler

newborn, heart block, pacemaker

Kaynakça

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