GKD Anest Yoð Bak Dern Derg. 2016; 22(1): 34-37 | DOI: 10.5222/GKDAD.2016.034

Stuck Kapak Nedeniyle Operasyona Alýnan Gebede Anestezi Yönetimi

Hülya Kaþýkara¹, Aslýhan Küçüker², Melahat Yýldýrým³, Cemile Altýn⁴, Gökçer Uður¹, Þemsi Mustafa Aksoy⁴, Abdulkadir But^4
1Atatürk Eðitim Araþtýrma Hastanesi. Anestezi Ve Reanimasyon Kliniði. Ankara
²Atatürk Eðitim Araþtýrma Hastanesi. Kalp Damar Cerrahi Kliniði. Ankara
³Yýldýrým Beyazýt Üniversitesi Týp Fakültesi Hastanesi. Kadýn Hast Ve Doðum Kliniði. Ankara
⁴Yýldýrým Beyazýt Üniversitesi Týp Fakültesi Hastanesi. Anestezi ve Reanimasyon Kliniði. Ankara

Giriþ: Mitral kapakta tromboz nedeniyle stuck kapak saptanan ve buna baðlý olarak akut kalp yetmezliði ve pulmoner ödem tablosunda acil operasyona aldýðýmýz 28 haftalýk gebenin anestezi yönetimi sunulmuþtur.
Olgu sunumu
Nefes darlýðý þikayeti ile baþvuran 28 haftalýk gebe, MVR( mitral valve replacement) stuck kapak saptanmasý üzerine acil operasyon için hastanemize sevkedilmiþtir. Transtorasik ekokardiyografisinde EF %55, protez mitral kapak disfonksiyene, açýlýmý kýsýtlý, sað boþluklarý ileri derecede dilate, pulmoner arter basýncý 65mmhg, 2-3.derece aort yetmezliði, 2.derece triküspit yetmezliði mevcut idi. Operasyon masasýna alýnan hastada, ekstremite uçlarýnda ve dudaklarda hafif siyanoz, takipne, ortopne ve hemoptizi mevcuttu. Batýn ultrasonografide uterusta 28 haftalýk canlý fetüs olduðu tespit edildi. Hastanýn, isteði doðrultusunda trombolitik tedavi baþlanmadý. Genel anestezi altýnda önce sezaryen ile bebek canlý olarak doðurtuldu ve ardýndan kardiyopulmoner baypass ile mitral kapak deðiþimi yapýldý.
Sonuç: Nonfonksiyone mitral kapak nedeniyle operasyona aldýðýmýz gebede uygun bir anestezi ve cerrahi planlama yapýlarak anne ve bebekte komplikasyon yaþanmadan operasyon tamamlandý.

Anahtar Kelimeler: Mitral tromboz, akciðer ödemi, genel anestezi, kardiyopulmoner bypass, gebe

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Anesthetic management of a pregnant patient who underwent surgery due to stuck valve

Hülya Kaþýkara¹, Aslýhan Küçüker², Melahat Yýldýrým³, Cemile Altýn⁴, Gökçer Uður¹, Þemsi Mustafa Aksoy⁴, Abdulkadir But^4
1Atatürk Training and Research Hospital. Anaesthesia and Reanimation. Ankara
²Atatürk Training And Research Hospital. Cardiovascular Surgery. Ankara
³Yýldýrým Beyazýt University School Of Medicine Hospital. Obstetrics And Gynecology. Ankara
⁴Yýldýrým Beyazýt University School Of Medicine Hospital. Anaesthesia and Reanimation. Ankara

Introduction: We report anasthetic management of a prosthetic valve thrombosis on a 28th week pregnant women, with acute heart failure and pulmonary oedema.
Case report:
A twenty-eight-week pregnant patient who visited a hospital with a complaint of dyspnea was sent to our clinic to undergo an urgent surgical intervention after diagnosed with mitral valve replacement stuck valve. Transthoracic echocardiography revealed EF %55, dysfunctional prosthetic mitral valve, restricted leaflet opening, severe dilatation in right atrium, pulmonary artery pressure of 65mmhg, aorta insufficiency of 2-3.degree, tricuspid incompetence of 2. degree. The surgeons observed mild cyanosis in extremities and lips, tachypnea, orthopnea, hemoptysis while the patient was on the operating table. Thrombolytic treatment was refused by the patient. The patient's Mmitral valve was replaced with cardiopulmonary bypass procedure following the live delivery of the baby with c-section under general anesthesia.
In conclusion the operation on the pregnant woman with nonfunctional mitral valve was successfully performed without any maternal and fetal complication following an appropriate anesthetic and surgical planning.

Keywords: Mitral valve thrombosis, pulmonary edema, general anesthesia, cardiopulmonary bypass, pregnant

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ATIF KOPYALA