ATRİOVENTRİKÜLER SEPTAL DEFEKT ONARIMI: KLASİK TEK YAMA VE ÇİFT YAMA TEKNİKLERİNİN KARŞILAŞTIRILMASI
Öz
Amaç: Komplet atriyoventriküler septal defektli pediatrik hastaların cerrahisinde genellikle farklı yama teknikleri kullanılmıştır. Bu çalışmada, komplet atriyoventriküler septal defekt onarımında klasik tek yama ve çift yama teknikleri ile ilgili tek merkezli, tek cerrah deneyimlerimiz ve sonuçlarımız anlatılmaktadır.
Gereç ve Yöntem: Bu retrospektif çalışma, Ankara Bilkent Şehir Hastanesi Çocuk Kalp ve Damar Cerrahisi Kliniğinde Komplet atriyoventriküler septal defekt ile intrakardiyak onarımı yapılan 30 hastayı kapsamaktadır. Çalışma Şubat 2019 ile Aralık 2021 arasında gerçekleştirilmiştir. Grup S’deki hastalara geleneksel tek yama yöntemi ile opere edilmiştir. (n = 20) Grup D’deki hastalar ise çift yama tekniği ile opere edilmiştir.(n = 10) Hastaların demografik ve klinik bilgileri kurumsal veri tabanlarından ve tıbbi kayıtlardan alındı. Postoperatif komplikasyonlar kaydedildi.
Sonuçlar: Kapakların preoperatif/postoperatif yetersizlik düzeyleri Wilcoxon Signed rank testi ile karşılaştırıldığında sol atriyoventriküler kapak için istatistiksel olarak anlamlı değilken sağ atriyoventriküler kapak için istatistiksel olarak anlamlı bulundu. (p=0,02) Her iki tekniğin postoperatif kapak yetersizliğini Kruskall-Wallis testi ile karşılaştırdığımızda, ameliyat öncesi bulgulardan bağımsız olarak postoperatif kapak yetersizliği ve fonksiyon arasında anlamlı bir fark bulunmadı.
Tartışma: Her iki ameliyat tekniği de operatif veya geç mortalite ve morbidite arasında fark yaratmadı. Cerrahın tecrübesine bağlı olarak ventriküler septal defekt boyutu kullanılacak tekniğin seçiminde kısıtlayıcı bir rol oynamaz. Burada açıklanan tek yama ve çift yama yöntemi, metodik, anlaşılır, tekrarlanabilir ve oldukça uzun ömürlüdür.
Anahtar Kelimeler
Atrioventriküler Septal Defekt Pulmoner Hipertansiyon Farklı tamir yöntemleri Endokardiyal yastıkçık defektleri.
Destekleyen Kurum
yok
Proje Numarası
yok
Kaynakça
- Anderson RH, Ho SY, Falcao S, Daliento L, Rigby ML. The diagnostic features of atrioventricular septal defect with common atrioventricular junction. Cardiol Young 1998 Jan;8(1):33-49.
- Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F. Moss and Adam’s Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult 9th ed. Philadelphia, PA: Wolters Kluwer; 2016.
- Litwin SB, Tweddell JS, Mitchell ME, Mussatto KA. The double patch repair for complete atrioventricularis communis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:21-27.
- Lillehei CW, Cohen M, Warden HE, Varco RL. The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation; results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery 1955;38:11-29.
- Jonas RA. Complete atrioventricular canal. In: Comprehensive surgical management of congenital heart disease, 2nd edn. Taylor & Francis Group, Boca Raton, 2014, pp 517–533
- Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardiovasc Surg 2007;19:249-257.
- Yildirim O, Avsar M, Ozyuksel A, Akdemir M, Zeybek C, Demiroluk S et al. Modified Single Versus Double-Patch Technique for the Repair of Complete Atrioventricular Septal Defect. J Card Surg 2015 Jul;30(7):595-600.
- Crawford FA. Atrioventricular canal: single-patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:11-20.
- Kanani M, Elliott M, Cook A, Juraszek A, Devine W, Anderson RH. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: the morphologic perspective. J Thorac Cardiovasc Surg 2006;132:640-646,
- Backer CL, Mavroudis C: Atrioventricular canal defect. In Mavroudis C, Backer CL (eds): Pediatric cardiac surgery 4th ed. Wiley-Blackwell, UK, 2013, pp. 342–360.
- Jonas RA, Mora B. Individualized approach to repair of complete atrioventricular canal: selective use of the traditional single-patch technique versus the Australian technique. World J Pediatr Congenit Heart Surg 2010;1:78-86.
- Razzouk AJ, Hasaniya NW, Bailey LL. Classic single-patch repair of atrioventricular septal defects. Operative Techniques in Thoracic and Cardiovascular Surgery 2015;20:75-86.
- Lacour-Gayet F, Campbell DN, Mitchell M, Malhotra S, Anderson RH. Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy. Cardiol Young 2006;3:52-58.
- Loomba RS, Flores S, Villarreal EG, Bronicki RA, Anderson RH. Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal Defect: A Systematic Review and Meta-Analysis. World J Pediatr Congenit Heart Surg 2019;10:616-623.
- Wu Y, Kuang H, Wang G, Dai J, Li Y, Wei G et al. Surgical Management for Complete Atrioventricular Septal Defects: A Systematic Review and Meta-Analysis. Pediatr Cardiol 2020 Oct;41(7):1445-1457.
Atrioventricular Septal Defects Repair: Comparison of Classic Single Patch and Double-Patch Techniques
Öz
Objective: Different patch techniques were virtually always used in the surgery of pediatric patients with complete atrioventricular septal defects. In this study, we described our single center, single surgeon experiences and results about the classic single patch and double patch techniques to repair complete atrioventricular septal defects.
Materials and Methods: This retrospective descriptive study included 30 patients who underwent intracardiac repair of complete atrioventricular septal defect in Ankara Bilkent City Hospital Department of Pediatric Cardiovascular Surgery. The study was conducted between February 2019 to December 2021. Patients in group S underwent surgery using the traditional single-patch method, while group D included patients who underwent repair using the double patch approach (n = 10). Patients’ demographic and clinical information was taken from institutional databases and medical records. Postoperative complications were recorded.
Results: When the preoperative/postoperative insufficiency levels of the valves were compared with the Wilcoxon Signed rank test, the findings were not statistically significant for the left atrioventricular valves, but were statistically significant for the right atrioventricular valves. (p=0.02) When we compared postoperative valve regurgitation of both techniques with the Kruskall-Wallis test, no significant difference was found between postoperative valve regurgitation and function, independent of preoperative findings.
Conclusion: Both operation techniques did not make a difference between operative or late mortality and morbidity. Depending on the surgeon’s experience, ventricular septal defect size does not play a restrictive role in the selection of the technique to be used. The single-patch and double patch method as described here is methodical, comprehensible, repeatable, and reasonably long-lasting.
Anahtar Kelimeler
Atrioventricular septal defect repair pulmonary hypertension different techniques for repair endocardial cushion defects.
Proje Numarası
yok
Kaynakça
- Anderson RH, Ho SY, Falcao S, Daliento L, Rigby ML. The diagnostic features of atrioventricular septal defect with common atrioventricular junction. Cardiol Young 1998 Jan;8(1):33-49.
- Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F. Moss and Adam’s Heart Disease in Infants, Children, and Adolescents, Including the Fetus and Young Adult 9th ed. Philadelphia, PA: Wolters Kluwer; 2016.
- Litwin SB, Tweddell JS, Mitchell ME, Mussatto KA. The double patch repair for complete atrioventricularis communis. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:21-27.
- Lillehei CW, Cohen M, Warden HE, Varco RL. The direct-vision intracardiac correction of congenital anomalies by controlled cross circulation; results in thirty-two patients with ventricular septal defects, tetralogy of Fallot, and atrioventricularis communis defects. Surgery 1955;38:11-29.
- Jonas RA. Complete atrioventricular canal. In: Comprehensive surgical management of congenital heart disease, 2nd edn. Taylor & Francis Group, Boca Raton, 2014, pp 517–533
- Backer CL, Stewart RD, Mavroudis C. What is the best technique for repair of complete atrioventricular canal? Semin Thorac Cardiovasc Surg 2007;19:249-257.
- Yildirim O, Avsar M, Ozyuksel A, Akdemir M, Zeybek C, Demiroluk S et al. Modified Single Versus Double-Patch Technique for the Repair of Complete Atrioventricular Septal Defect. J Card Surg 2015 Jul;30(7):595-600.
- Crawford FA. Atrioventricular canal: single-patch technique. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2007:11-20.
- Kanani M, Elliott M, Cook A, Juraszek A, Devine W, Anderson RH. Late incompetence of the left atrioventricular valve after repair of atrioventricular septal defects: the morphologic perspective. J Thorac Cardiovasc Surg 2006;132:640-646,
- Backer CL, Mavroudis C: Atrioventricular canal defect. In Mavroudis C, Backer CL (eds): Pediatric cardiac surgery 4th ed. Wiley-Blackwell, UK, 2013, pp. 342–360.
- Jonas RA, Mora B. Individualized approach to repair of complete atrioventricular canal: selective use of the traditional single-patch technique versus the Australian technique. World J Pediatr Congenit Heart Surg 2010;1:78-86.
- Razzouk AJ, Hasaniya NW, Bailey LL. Classic single-patch repair of atrioventricular septal defects. Operative Techniques in Thoracic and Cardiovascular Surgery 2015;20:75-86.
- Lacour-Gayet F, Campbell DN, Mitchell M, Malhotra S, Anderson RH. Surgical repair of atrioventricular septal defect with common atrioventricular valve in early infancy. Cardiol Young 2006;3:52-58.
- Loomba RS, Flores S, Villarreal EG, Bronicki RA, Anderson RH. Modified Single-Patch versus Two-Patch Repair for Atrioventricular Septal Defect: A Systematic Review and Meta-Analysis. World J Pediatr Congenit Heart Surg 2019;10:616-623.
- Wu Y, Kuang H, Wang G, Dai J, Li Y, Wei G et al. Surgical Management for Complete Atrioventricular Septal Defects: A Systematic Review and Meta-Analysis. Pediatr Cardiol 2020 Oct;41(7):1445-1457.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Original Article |
| Yazarlar | |
| Proje Numarası | yok |
| Erken Görünüm Tarihi | 29 Ağustos 2023 |
| Yayımlanma Tarihi | 31 Ağustos 2023 |
| Gönderilme Tarihi | 17 Mayıs 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 33 Sayı: 4 |
Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.