Sol ventrikül fonksiyon bozukluğu olan, kritik aort stenozu olgularında aort kapak replasmanı: 35 hastada aort kapak replasman sonuçları
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Dosyalar
Tarih
2004
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Düşük ejeksiyon fraksiyonu (EF) ve düşük transvalvuler gradiyenti olan aort stenozu (AS) olgularında cerrahi sonuçlar henüz yüz güldürücü seviyelere ulaşmamıştır. Çalışmamızın amacı bu olgularda merkezimizde yapılan aort valv replasman (AVR) sonuçlarını analiz etmektir. Gereç ve Yöntem: Aralık-1999-2003 tarihleri arasında merkezimizde dobutamin stres ekokardiografi testi ile gerçek aort stenozu tanısı konulan, sol ventrikül fonksiyon bozukluğu olan ve AVR ameliyatı uygulanan 35 hasta çalışma grubuna dahil edilmiştir. Hastaların tümünün 2 boyutlu transtorasik ekokardiografi ile, ejeksiyon fraksiyonları, ortalama aort kapak alanı ve gradiyentleri preoperatif olarak değerlendirilmiştir. Hasta grubunda preoperatif ortalama EF 27±9.2 EF ünitesi, ortalama kapak alanı 0.8±0.4 cm2, ortalama gradiyent ise 26±2 mmHg. idi. Hastaneye başvuran hastaların %91'nin fonksiyonel kapasitesi New York Kalp Cemiyeti (NYHA) sınıf 3-4 idi. Bulgular: Postoperatif erken dönemde 6 hasta (%17), ortalama 21 ay takip süresince 4 hasta (%11) kaybedildi. Postoperatif 25 hastada EF değerlendirildi. Ortalama EF artışı, 14±8 EF ünitesi ile anlamlı bulundu (p<0.05). Yaşayan 23 hastanın (%66) fonksiyonel kapasitesi NYHA sınıf 1-2 idi. Sonuç: Sol ventrikül disfonksiyonu gelişen, düşük gradiyentli aort stenozu vakalarında ameliyat mortalitesi normal ventriküllü hastalara göre yüksek olsa da kabul edilebilir oranlardadır. Ameliyat sonrası sağkalım ve fonksiyonel kapasitedeki artış tıbbi tedaviye göre cerrahi lehinedir.
Aim: Surgical results of the cases with aortic valve stenosis, and low ejection fraction (EF) and low gradient has not satisfactory yet. The purpose of the present study is to report on the operation results of AVR in patients with low output, low gradient aortic stenosis. Material and Method: This study consisted of 35 patients with low gradient aortic stenosis (mean transvalvular gradient <30 mm Hg), and severe LV systolic dysfunction (EF <35%). On the basis of the results of dobutamin stres test these patients underwent aortic replacement between december 1999-2003. Preoperative ejection fraction (EF), mean aortic pressure gradient, and aortic valve area were recorded by echocardiography (ECG). All patients had calculated mean valve areas of 0.8±0.4 cm2 and mean gradients 26±2 mm Hg, mean preoperative EF 27±9.2%. Ninety one percent of patients were in New York Heart Association (NHYA) functional class III/IV at admission to the hospital. Results: Six patients died in the early postoperative period (30 days), Four additional patients died during median follow-up 21 months. Postoperative EF were analysied on 25 patients. Mean EF increase was 14±8 %, which is found significant (p<0.05). Functional capacitiy of 23 alive patients (%66) were NYHA classI/II status. Conclusions: Although surgical mortality on the patients with aortic stenosis who had left ventricular dysfunction is high, it is still in an acceptable limit. Survival and increased functional capacity rates after operation, favour surgical therapy to the medical therapy.
Aim: Surgical results of the cases with aortic valve stenosis, and low ejection fraction (EF) and low gradient has not satisfactory yet. The purpose of the present study is to report on the operation results of AVR in patients with low output, low gradient aortic stenosis. Material and Method: This study consisted of 35 patients with low gradient aortic stenosis (mean transvalvular gradient <30 mm Hg), and severe LV systolic dysfunction (EF <35%). On the basis of the results of dobutamin stres test these patients underwent aortic replacement between december 1999-2003. Preoperative ejection fraction (EF), mean aortic pressure gradient, and aortic valve area were recorded by echocardiography (ECG). All patients had calculated mean valve areas of 0.8±0.4 cm2 and mean gradients 26±2 mm Hg, mean preoperative EF 27±9.2%. Ninety one percent of patients were in New York Heart Association (NHYA) functional class III/IV at admission to the hospital. Results: Six patients died in the early postoperative period (30 days), Four additional patients died during median follow-up 21 months. Postoperative EF were analysied on 25 patients. Mean EF increase was 14±8 %, which is found significant (p<0.05). Functional capacitiy of 23 alive patients (%66) were NYHA classI/II status. Conclusions: Although surgical mortality on the patients with aortic stenosis who had left ventricular dysfunction is high, it is still in an acceptable limit. Survival and increased functional capacity rates after operation, favour surgical therapy to the medical therapy.
Açıklama
Anahtar Kelimeler
Aort Stenozu, Düşük Ejeksiyon Fraksiyonu, Düşük Aortik Gradiyent, Aortic Stenosis, Low Ejection Fraction, Low Aortic Valve Gradient
Kaynak
MN Kardiyoloji
WoS Q Değeri
Scopus Q Değeri
Cilt
11
Sayı
3
