Journals / Türk Göğüs Kalp Damar Cerrahisi Dergisi / 2004 / Cilt: 12 - Sayı: 1
Surgical correction of patent ductus arteriosus under deep hypothermic circulatory arrest
- Pages
- 26–29
- DOI
- —
Abstract
Background: Repair of complicated patent ductus arteriosus by conventional methods is dangerous as life-threatening hemorrhages may occur. Thus, in these patients, it is safer to operate by using cardiopulmonary bypass and hypothermic circulatory arrest. Methods: We operated on 5 patients with patent ductus arteriosus with deep hypothermia and total circulatory arrest between 1993 and 2003. All of the patients were female and their ages were between 9 and 51. The mean shunt ratio was 2.7 + 0.45 and mean systolic pulmonary arterial pressure was 59 ± 17.46 mmHg. In three of the patients the ductus was wide and thick, it was aneurysmatic in one and calcified in the other. All of the patients were operated under cardiopulmonary bypass and were cooled down to an -average temperature of 21.6 + 2.07 °C. The mean total circulatory arrest time was 14.4 ± 9.66 minutes (range 3-25). In two patients, the ductus was closed with a transpulmonary approach while in one patient a transaortic approach was. used. All sutures were consolidated with pledgets. In one patient the transfixation was performed without pulmonary arteriotomy using three pledgetted sutures placed externally. In the last one patient, the repair was achieved by division. In addition to patent ductus arteriosus correction, concomitant procedures were subaortic discrete membrane resection, aortic valve replacement in two patients. In one patient, right ventricular outflow tract was enlarged with a transannular patch and foramen ovale was closed. Results: There was no early or late mortality. In two patients inotropic support was needed during weaning from cardiopulmonary bypass. No complications were seen related to the procedure itself. The mean follow up was 31.8 ± 39.97 months. No recanalisation was detected with the postoperative echocardiographic assessment. Conclusions: Hypothermic totalv circulatory arrest can be used safely during the repair of complicated patent ductus arteriosus without exposing the patient to additional risks.
Özet
Amaç: Komplike patent duktus arteriosuslu vakalarda geleneksel yöntemlerle tamir tehlikeli olup, ölümcül kanamalara yol açabilir. Bu nedenle bu vakalarda, kardiyopulmoner bypass ve derin hipotermik sirkulatuvar arrestte onarımın yapılması daha güvenli olmaktadır. Materyal ve Metod: Kliniğimizde 1993 - 2003 tarihleri arasında 5 hastaya derin hipotermik total sirkulatuvar arrest ile duktus onarımı gerçekleştirildi. Hastaların hepsi kadın olup, yaşlan 9 ile 51 yıl arasında değişmekteydi. Ortalama şant oranı 2.7 ± 0.45 olup, ortalama sistolik pulmoner arter basıncı 59 ± 17.46 mmHg idi. Vakaların üçünde duktus kalın ve geniş olup, birinde anevrizmatik, diğerinde ise kalsifik idi. Hastaların hepsinde kardiyopulmoner bypassa girilerek hastalar ortalama 21.6 ± 2,.07 °C'ye kadar soğutuldu. Ortalama 14.4 + 9.66 dakika (3-25) total sirkulatuvar arrestte kalındı. İki hastada onarım transpulmoner yolla yapılırken, bir vakada transaortik yolla yaklaşılarak pledget destekli dikişlerle onarını yapıldı. Bir hastada pulmoner arter açılmadan dışardan üç adet pledgetli sütür ile transfiksiyon, geri kalan bir hastada ise divizyon yapılarak onarım gerçekleştirildi. Ek prosedür olarak iki hastada subaortik diskret membran rezeksiyonu, bir hastada aort kapak replasmam, bir hastada ise sağ ventrikül çıkış yolu transannuler yama ile genişletildi ve patent foramen ovale kapatıldı. Bulgular: Erken veya geç mortalite görülmedi. İki hastada kardiyopulmoner bypass çıkışında inotrop destek gerekti. Hiçbir hastada prosedüre ait komplikasyon görülmedi. Hastalar ortalama 31.8 ± 39.97 ay izlendi. Yapılan postoperatif ekokardiyografilerinde hiçbir vakada rekanalizasyon görülmedi. Sonuç: Komplike olan patent duktus arteriosuslu vakaların tamirinde derin hipotermik total sirkulatuvar arrest hastaya ek bir risk getirmeden güvenle uygulanabilir.