Endarterektomisiz patch plasty tekniği kullanılan koroner bypass hastalarında koroner akım rezervinin transtorasik ekokardiyografi ile değerlendirilmesi
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2010
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Maltepe Üniversitesi, Tıp Fakültesi
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info:eu-repo/semantics/openAccess
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Giriş ve Amaç:Koroner arter hastalığında cerrahi girişimlerin temel amacı canlı miyokard dokusunu kanlandıran, tıkalı ya da lezyonlu koroner arterlerin tam revaskülarizasyonudur [1]. Özellikle de Left Anterior Descending Arter revaskülarizasyonu erken ve geç dönem mortaliteyi etkilemesi nedeniyle ayrıca önemlidir. Biz vakalarımızda; diffüz aterosklerotik hastalığı tespit edilen LAD koroner arterini darlık boyunca uzun segment açarak [2-4.5cm (m: 2.83±0.82cm)], endarterektomi yapmadan LIMA grefti ile direkt uzun anastamoz patch plasty bypass tekniğini kullandık. Yapılan bazı araştırmalarda transtorasik ekokardiyografinin koroner akım rezervinin değerlendirilmesinde girişimsel yöntemler kadar başarılı olduğu gösterilmiştir [21]. Hastalarda transtorasik ekokardiyografi ile koroner akım rezervindeki değişimleri ve epikardiyal darlık olup olmadığını araştırmayı amaçladık.Gereç ve Yöntem:Ameliyatı ve postoperatif değerlendirmesi yapılan 40 hastanın postoperatif orta ve geç dönem değerlendirmesi için; transtorasik ekokardiyografi ile LAD lokalizasyonunda koroner akım rezervine bakılmış ve koroner akım rezervi düşük bulunan hastalara koroner anjiyografi yapılmıştır.Bulgular:Hastaların tümünde LAD' ye endarterektomisiz patch plasty yapıldı. Patch plasty uzunluğu 2-4,5 cm (m: 2,83±0,82 cm) olarak ölçülmüştür. Çalışma grubunda EF değerlerinin ortalaması % 53,83±7,90 ölçülmüştür. Hastalar; yetersiz koroner akım rezervi ölçülen [(CFR <2) n=5, %12,0] ve normal koroner akım rezervi ölçülen [(CFR?2) n=35, %88] olarak iki gruba ayrıldı. CFR değeri 2' nin altında olan hastaların (n=5) patch plasty uzunluğu ile (m: 3,6±0,82 cm), CFR' si normal olan hastaların (n=35) patch plasty uzunluğu (m: 2,69±0,75 cm) karşılaştırıldığında, CFR' si düşük olan grupta patch plasty uzunluğunun istatistiki olarak anlamlı şekilde daha uzun olduğu bulundu (p=0.032).Tartışma ve Sonuç:Günümüzde, iskemik KAH'nın görülme sıklığındaki artışa paralel olarak koroner arter bypass cerrahisi yapılan hasta sayısı da artmıştır. Bu çalışma heterojen kardiyovasküler hastalık geçmişi olan, koroner bypass greftleme işlemi yapılmış hastalarda TTDE' nin koroner arter hastalığını saptamadaki güvenilirliğini ortaya koymuştur. Öyle düşünülmektedir ki TTDE yakın gelecekteki önemli çalışmaları tetikleyecek klinik güce ve anlama sahiptir.
Introduction:The main aim of surgical interventions to coronary artery is revascularization of living myocardial tissue via the bypass of narrowed or stenotic coronary arteries [1]. Revascularization of Left Anterior Descending coronary artery (LAD) has a major effect on early and late mortality rates. During the bypass procedure a long arteriotomy [2-4.5cm (m: 2.83±0.82cm)], without endarterectomy, was made on LAD through the narrowed segment in all diffuse atherosclerotic coronary artery disease patients. LIMA graft anastomosis was made to LAD. Some studies have showed that transthoracic echocardiography to evaluate the coronary flow reserve is effective as interventional methods [21]. We aimed to show the changes on coronary flow reserve and whether there is an epicardial coronary narrowing or not.Material and Method: Forty operated patients? postoperative early and late term transthoracic echocardiographic analyses were made to evaluate the coronary flow reserve in LAD localization. Coronary angiography was made for the patients with lower coronary flow reserve.Results: For all patients, patch plasty without endarterectomy were made to LAD. The length of patch plasties were 2-4.5cm (m: 2,83±0,82 cm). The mean ejection fraction was %53.83±7,90. The patient group was divided into two by considering their coronary flow reserve. First group includes the patients with low coronary flow reserve [(CFR <2) n=5, %12,0] and the second represents the patients with normal coronary flow reserve CFR?2) n=35, %88]. By comparing the patients? whose CFR is bellow 2 (n=5) and have short patch plasties (m: 3,6±0,82 cm) in length, the patients with normal CFR (n=35) was found to have longer patch plasties in length (m: 2,69±0,75 cm). That means the patient group with lower CFR values represents a significant statistical difference for longer patch plasties (p=0.032).Conclusions: There is a significant increase of the number of patients with coronary artery disease. Therefore there is an obvious increase in the number of coronary artery bypass operations. This study shows the efficacy and reliability of TTDE for detecting coronary artery disease of the patients with heterogenous cardiovascular disease history. By the way there is a strong belief for TTDE will be a triggering factor of further studies about non invasive imaging of coronary artery disease.
Introduction:The main aim of surgical interventions to coronary artery is revascularization of living myocardial tissue via the bypass of narrowed or stenotic coronary arteries [1]. Revascularization of Left Anterior Descending coronary artery (LAD) has a major effect on early and late mortality rates. During the bypass procedure a long arteriotomy [2-4.5cm (m: 2.83±0.82cm)], without endarterectomy, was made on LAD through the narrowed segment in all diffuse atherosclerotic coronary artery disease patients. LIMA graft anastomosis was made to LAD. Some studies have showed that transthoracic echocardiography to evaluate the coronary flow reserve is effective as interventional methods [21]. We aimed to show the changes on coronary flow reserve and whether there is an epicardial coronary narrowing or not.Material and Method: Forty operated patients? postoperative early and late term transthoracic echocardiographic analyses were made to evaluate the coronary flow reserve in LAD localization. Coronary angiography was made for the patients with lower coronary flow reserve.Results: For all patients, patch plasty without endarterectomy were made to LAD. The length of patch plasties were 2-4.5cm (m: 2,83±0,82 cm). The mean ejection fraction was %53.83±7,90. The patient group was divided into two by considering their coronary flow reserve. First group includes the patients with low coronary flow reserve [(CFR <2) n=5, %12,0] and the second represents the patients with normal coronary flow reserve CFR?2) n=35, %88]. By comparing the patients? whose CFR is bellow 2 (n=5) and have short patch plasties (m: 3,6±0,82 cm) in length, the patients with normal CFR (n=35) was found to have longer patch plasties in length (m: 2,69±0,75 cm). That means the patient group with lower CFR values represents a significant statistical difference for longer patch plasties (p=0.032).Conclusions: There is a significant increase of the number of patients with coronary artery disease. Therefore there is an obvious increase in the number of coronary artery bypass operations. This study shows the efficacy and reliability of TTDE for detecting coronary artery disease of the patients with heterogenous cardiovascular disease history. By the way there is a strong belief for TTDE will be a triggering factor of further studies about non invasive imaging of coronary artery disease.
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Ertürk, E. (2010). Endarterektomisiz patch plasty tekniği kullanılan koroner bypass hastalarında koroner akım rezervinin transtorasik ekokardiyografi ile değerlendirilmesi / Assesment of coronary flow reserve with transtorasic echocardiography in coronary bypass patients with patch plasty technic without using endarterectomy (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
