Tek Hastada İki Kapak Replasmanı, Kapak Tamiri ve Cryoablasyon
Özet
Bu metin, kalp kapak hastalıkları ve atriyal fibrilasyon (AF) ile ilişkili kompleks bir vaka sunumu içermektedir. 68 yaşındaki erkek hastada ciddi aort stenozu, mitral yetmezlik (Barlow tipi), triküspit yetmezlik ve AF birlikte gözlenmiştir. Hasta nefes darlığı şikayetiyle başvurmuş, ekokardiyografide ejeksiyon fraksiyonu %50 ile multipl kapak patolojileri saptanmıştır. Operasyon öncesi stabilizasyon sonrası mediyan sternotomi ile cerrahi gerçekleştirilmiştir: Aort kapak eksizyonu sonrası Corcym marka dikisiz biyolojik aort kapak implantasyonu, Barlow mitral kapakta subvalvüler yapı korunarak 31 no'lu Corcym mitral kapak replasmanı, triküspit için De-Vega anuloplastisi ve AF için -110/-120°C kriyoablasyon (pulmoner ven izolasyonu ile Maze benzeri) uygulanmıştır. Pompa ve kros klemp süreleri kısaltılmış, intraoperatif TEE'de kaçak yokluğu doğrulanmıştır. Hasta postoperatif 10. günde warfarin ile taburcu edilmiştir; komplikasyonsuz seyir gözlenmiştir. Metin, kapak hastalıklarının epidemiyolojisini (insidans 100.000'de 64, %70'i 65 yaş üstü) ve cerrahi endikasyonları (ESC/ACC rehberleri) detaylandırır. Dikisiz aort kapak avantajları (kısa süre, az transfüzyon), kriyoablasyonun etkinliği ve literatür karşılaştırmaları vurgulanır. Bu kompleks prosedürün Doğu Anadolu'da başarıyla uygulanması, ulusal kalp cerrahisi gelişimini simgeler.
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