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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.
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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
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  • 2
137-139
  • Turkish

REFERENCES

References: 

Kaynaklar
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