Fallot Tetralojisi Vakalarında Kardiyak Fibrozisin Incelenmesi ve Cerrahi Sonuçlarına Etkisinin Belirlenmesi

Abstract

TOF repair can be performed with low morbiditiy and mortality in many centers. However, it is well established that some patients can experience a prolonged, troublesome postoperative recovery, associated with higher inotopic scores, prolonged ventilation, longer stay in intensive care and hospital. In recent years, new concept called restrictive physiology of right ventricle was introduced and was held responsible for those complications. Underlying pathophysiologic explanation for this concept can be defined as combined myocyte injury and fibrosis in right ventricle of patients with TOF that occured in response to chronic hypoxia and volume overload, even before corrective surgery. In this study, we analyze myocyte injury and fibrosis with histopathological and ultrastructural methods in right ventricle outflow tract muscle tissues that obtained from 14 patients with TOF during corrective surgery. Furthermore, we aimed to determine correlation between these changes with early surgical outcomes. Patients divided into two even groups: cyanotic and non-cyanotic, based on their oxygen saturations at rest (<90% and >90%). Pre-, intra and postoperative characteristics of patients were recorded. There were no significant differences between the group with regard to pre- and intraoperative variables. There was no mortality. But inotropic score, inotropic therapy duration, intensive care stay and in-hospital stay were found significantly higher in cyanotic group. Histopathologic examination revealed that miyocyte injury and ultrastructurally defined mitochondria injury score were also higher in cyanotic patients. Despite all patients showed some degree of fibrosis in their specimens, cyanotic patients had more severe fibrosis than non-cyanotic patients. Nonetheless, we found no correlation between histopathological alterations and early surgical outcomes. Incidentally, we detected positive correlation in between preoperative history of spell and poor early surgical outcomes. As a result, we showed that myocyte injury and fibrosis had been occured even before TOF repair and cyanotic patients had more severe myocyte injury and fibrosis. But these alterations were not in correlation with early surgical outcomes.