You are here

Home » Content

Kordal korumanın fark edilmeyen avantajı: prostetik kapak endokarditinin sınırlanması

Undetected advantage of chordal preservation: restriction of prosthetic valve endocarditis

Journal Name:

  • Gülhane Tıp Dergisi

Publication Year:

  • 2010

Key Words:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
A young male patient who was operated for prosthetic mitral valve replacement admitted to our clinic at fourth postoperative month with loss of equilibrium, fatigue and fever. There were two vegetations on the anterior portion of the sewing ring and a large dehiscense area from the anterior annulus on echocardiography. Gram positive coccus was revealed in the gram colouring. Patient was taken to emergency operation with all these findings. When we excised both the prosthetic valve and native valve tissue, it was seen that infection was limited due to the chordal preservation in the prior operation. There was no clue for infection on the annulus and the anterior annulus was intact for valve re-replacement. We only applied pericardial patchplasty to the posterior annulus where we made a superficial debridement in order to create a smooth surface to enhance a difficult attachment zone for the microorganisms. It is very obvious that chordal preserved mitral valve replacement operation enhances and preserves the left ventricular function. Moreover chordal preservation technique may provide a better intact annulus and enough infection free area for reoperation due to infection.
Bookmark/Search this post with
Abstract (Original Language): 
Mitral kapak hastalığı tanısı ile mitral kapak replasmanı uygulanan genç erkek hasta postoperatif dördüncü ayda denge bozukluğu, halsizlik ve yüksek ateş şikâyeti ile kliniğimize başvurdu. Yapılan ekokardiyografide prostetik kapak dikiş hattının anteriyorunda iki adet vejetasyon ve anteriyor anulusda geniş ayrılma saptandı. Gram boyamada gram pozitif kok saptanması üzerine hasta acil operasyona alındı. Operasyonda prostetik kapağın ve enfekte dokuların rezeksiyonu sonrası yapılan incelemede enfeksiyonun kordal korumaya bağlı olarak sınırlı kaldığı görüldü. Anteriyor anulusda kapak re-replasmanı için yeterli sağlam doku kaldığı gözlendi. Süperfisiyal debridman uyguladığımız posteriyor anulusa enfeksiyona dirençli pürüzsüz saha elde etmek için perikardiyal yama uyguladık. Kordal korumalı mitral kapak replasmanı, kapak koaptasyonu ve sol ventrikül fonksiyonu üzerine olumlu etkilerinin yanında, enfeksiyon nedeni ile reoperasyon gerektiğinde enfeksiyonu sınırlandırabilmekte, anulusda daha fazla hasarsız alan kalmasını sağlayabilmekte ve cerrahiyi kolaylaştırabilmektedir
FULL TEXT (PDF): 
PDF icon arastirmax-kordal-korumanin-fark-edilmeyen-avantaji-prostetik-kapak-endokarditinin-sinirlanmasi.pdf
  • 2
137-139
  • Turkish

REFERENCES

References: 

Kaynaklar
1. Yılmaz AT, Oz BS, Kucukaslan N, Gunay C, Yılmaz M.
Preservation of anterior leaflet chordae with modified
Miki technique. J Card Surg 2005; 20: 70-72.
2. Talwar S, Jayanthkumar HV, Kumar AS. Chordal
preservation during mitral valve replacement: basis,
techniques and results. Indian J Thorac Cardiovasc Surg
2005; 21: 45-52.
3. Miki S, Kusuhara K, Ueda Y, Komeda M, Ohkita Y,
Tahata T. Mitral valve replacement with preservation of
chordae tendineae and papillary muscles. Ann Thorac
Surg 1988; 45: 28-34.
4. David TE. Mitral valve replacement with preservation
of chordae tendineae. Rationale and technical
considerations. Ann Thorac Surg 1986; 41: 680-682.
5. Chowdhury UK, Kumar AS, Airan B, et al. Mitral valve
replacement with and without chordal preservation
in a rheumatic population: Serial echocardiographic
assessment of left ventricular size and function. Ann
Thorac Surg 2005; 79: 1926-1933.
6. Cingöz F, Günay C, Kuralay E, et al. Both leaflet
preservation during mitral valve replacement: modified
anterior leaflet preservation technique. J Card Surg
2004; 19: 528-534.
7. Filsoufi F, Adams DH. Surgical treatment of mitral valve
endocarditis. In: Cohn LH, Edmunds LH (eds). Cardiac
Surgery in the Adult. 2nd ed. McGraw-Hill Medical
Publishing Division, 2003: 987-997.
8. Choussat R, Thomas D, Isnard R, et al. Perivalvular
abscess associated with endocarditis. Eur Heart J 1999;
20: 232-241.
9. Delay D, Pellerin M, Carrier M, et al. Immediate and
long-term results of valve replacement for native and
prosthetic valve endocarditis. Ann Thorac Surg 2000;
70: 1219-1223.

Thank you for copying data from http://www.arastirmax.com