AKUT AORT SENDROMLARI

AkutAortSendromlariKapak

AORTSENDROMLARININTÜRLERİ

Ebubekir Sönmez1 Alperen Yıldız2 Bilgehan Erkut3

1Kütahya Şehir Hastanesi, Kalp Damar Cerrahisi Kliniği, Kütahya, Türkiye
2Atatürk Üniversitesi, Tıp Fakültesi, Kalp Damar Cerrahisi AD, Erzurum, Türkiye
3Atatürk Üniversitesi, Tıp Fakültesi, Kalp Damar Cerrahisi AD, Erzurum, Türkiye

Sönmez E, Yıldız A, Erkut B. Aort Sendromlarının Türleri. Ünlü Y, editör. Akut Aort Sendromları. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.53-62.

ÖZET

Akut aort sendromu (AAS), aort diseksiyonu (AD), intramural hematom (İMH) ve penetre aterosklerotik ülser (PAÜ) olmak üzere üç majör klinik tablodan oluşan, hayatı tehdit eden bir spektrumu ifade eder. Bu üç patoloji, çoğu zaman benzer klinik bulgularla ortaya çıkar ve hızlı tanı ile tedavi edilmediğinde yüksek mortalite oranları ile seyreder. AD, intima tabakasındaki yırtığın media tabakasına uzanması ve gerçek ile yalancı lümenlerin oluşmasıyla karakterizedir. Tip A diseksiyonlar genellikle asendan aortayı tutar ve acil cerrahi gerektirir; Tip B diseksiyonlar ise genellikle inen aortada görülür ve çoğu kez medikal olarak yönetilir. İMH, intimal yırtık olmadan media tabakasında kan birikimiyle tanımlanır. Bu durum, diseksiyona ilerleyebileceği için özellikle erken dönemde sıkı takip gerektirir. Tip A İMH cerrahi girişim gerektirebilirken, Tip B İMH çoğu zaman medikal tedaviyle yönetilir. PAÜ ise aterosklerotik plağın intima ve media tabakalarını penetre etmesiyle ortaya çıkar. Genellikle ileri yaş ve aterosklerotik risk faktörleri ile ilişkili olup en sık inen torasik aortada görülür. Çap ve derinlik arttıkça rüptür riski artar; bazı olgularda İMH veya diseksiyona dönüşebilir. Asemptomatik ve stabil hastalar medikal tedavi ile izlenebilirken, semptomatik veya komplikasyon gelişen olgular endovasküler ya da cerrahi tedavi gerektirebilir. AAS tanısında bilgisayarlı tomografi anjiyografi temel görüntüleme yöntemidir. Erken tanı, kan basıncı ve kalp hızının agresif kontrolü ile mortalite azaltılabilir. Günümüzde endovasküler girişim tekniklerindeki ilerlemeler, daha az invaziv tedavi seçeneklerinin kullanımını artırmıştır. Sonuç olarak, AAS yüksek mortalite potansiyeline sahip olup hızlı tanı, uygun tedavi stratejileri ve düzenli takip ile hasta prognozu belirgin şekilde iyileştirilebilir.

Anahtar Kelimeler: Akut aort sendromu; Aort diseksiyonu; İntramural hematom; Penetran aterosklerotik ülser; Klinik sunum

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