AKUT AORT SENDROMLARI

AkutAortSendromlariKapak

ÖLÜM SEBEPLERİ

Büşra Temel Yüksel

Ağrı Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, Ağrı, Türkiye

Temel Yüksel B. Ölüm Sebepleri. Ünlü Y, editör. Akut Aort Sendromları. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.83-95.

ÖZET

Aortun media tabakasındaki yapısal bozulmalar sonucu gelişen akut aortik sendromlar (AAS), hayatı tehdit edici sonuçlar doğurabilen, hızlı ve profesyonel şekilde yönetilmesi gereken bir spektrumdur. Bu spektrum aort diseksiyonu, intramural hematom (İMH) ve penetran ateresklerotik ülser (PAÜ) gibi klinik durumları kapsar. Kardiyovasküler cerrahinin acilleri arasında olan bu klinik spektrum, çeşitli patofizyolojik süreçlerle yüksek mortalite oranlarını da beraberinde getirmektedir. Bu üç alt tipin patofizyolojileri ve etyolojileri birbirlerinden farklı olsa da yüksek mortalite oranları ve tanı-tedavideki yönetim süreçleriyle benzerlik göstermektedirler.

Atipik klinik prezantasyon ve yanlış tanıların konulması sonucu tanı ve tedavi sürecinde gecikmelerin yaşanması en baştaki ölüm sebeplerinden biridir. Özellikle akut diseksiyonlarda tanı ve tedavideki her 1 saatlik gecikme %1-2 oranında mortalite artışı ile sonuçlanır. Tedavi edilmediklerinde ilk 48 saatte mortalite oranı %50’lere ulaşmaktadır. Zamanında tanı ve müdahale kritik öneme sahiptir ve en belirleyici prognostik faktörlerden biridir. Tedaviye kadarki süreçte hemodinamik stabiliteyi sağlamak ve özellikle tansiyon regülasyonu oldukça önem arz eder. Kontrolsüz hipertansiyon diseksiyon insidansını artırdığı gibi, tamponad, rüptür ve organ malperfüzyonları gibi ölümcül komplikasyonlara da yol açarak mortaliteyi artıran diğer bir ölüm sebebi olarak ortaya çıkmaktadır.

AAS’lerde mortaliteye neden olan çeşitli patofizyolojik süreçler mevcuttur. Hastalığın tipi, yerleşimi, komorbid durumlar, merkezin tecrübesi gibi birçok etken de ölüm riskini etkiler. Ama bu spektrumun tüm tiplerinde en sık görülen ortak ölüm sebebi aortik rüptürdür. Tip A aort diseksiyonunda kardiyak tamponad, akut aort kapak yetmezliği, akut miyokard enfarktüsü, serebrovasküler malperfüzyonlar gibi gelişen patolojiler başlıca ölüm sebeplerini oluşturur. Tip B aort diseksiyonunda özellikle de komplike tipte ise rüptürden sonra gelen en sık ölüm sebebi malperfüzyon sendromlarıdır. En sık karşılaşılan malperfüzyon bulguları spinal kord iskemisi, mezenterik iskemi, renal iskemi, alt ekstremite iskemileridir. Bu bulgular izole görülebildikleri gibi kombine şekilde de ortaya çıkabilir ve multiorgan disfonksiyon sendromuna yol açarak mortaliteyi önemli ölçüde artırır. Diseksiyonların antegrad veya retrograd ilerleyebilmesi ve yaratabileceği ortak klinik bulgular nedeniyle tipler arasında net sınırlar yoktur ve hepsinde benzer mortal sonuçlar ortaya çıkabilir. İMH ve PAÜ’nün aortik diseksiyona veya rüptüre dönüşme potansiyeli nedeniyle diseksiyonlarla ölüm sebepleri benzerdir. Bu patolojilerin yakın takibi ve zamanında tedavisi hayati önemdedir. Açık cerrahi ve endovasküler cerrahiye sekonder komplikasyonlar, re-diseksiyonlar, yeni gelişen anevrizmatik dilatasyonlar ve enfeksiyonlar da mortaliteye katkıda bulunan diğer sebeplerdir. Zamanında tanı, uygun tedavi ve sonrasında hastaların yakın takibi mortaliteyi anlamlı ölçüde düşürecektir. Bu bölümde ölüm sebepleri tiplere ve zamana göre sınıflandırılarak anlatılacaktır.

Anahtar Kelimeler: Akut aort sendromu; Aort diseksiyonu; Aortik rüptür; Malperfüzyon; Mortalite

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