AKUT AORT SENDROMLARI

AkutAortSendromlariKapak

PATOFİZYOLOJİ VE EPİDEMİYOLOJİ

Özlem Çakırköse

Giresun Üniversitesi, Tıp Fakültesi, Kalp Damar Cerrahisi AD, Giresun, Türkiye

Çakırköse Ö. Patofizyoloji ve Epidemiyoloji. Ünlü Y, editör. Akut Aort Sendromları. 1. Baskı. Ankara: Türkiye Klinikleri; 2025. p.11-23.

ÖZET

Akut aortik sendrom; aort diseksiyonu, intramural hematom ve semptomatik penetre aortik ülseri kapsayan, hayatı tehdit eden klinik bir durumdur. Bu üç patoloji, çoğu zaman torakal aort anevrizması veya travmatik aort rüptürüne ilerleyebilecek dinamik süreçlerdir. En sık görülen tablo aort diseksiyonudur. Özellikle Tip A aort diseksiyonu acil cerrahi müdahale gerektirirken, Tip B diseksiyonları sıklıkla endovasküler yöntemlerle tedavi edilmektedir.

İntramural hematom, intimal yırtık olmadan aort duvarında gelişen hematom olarak tanımlanır. Bu tablo, ilerleyen dönemde rüptüre, klasik aort diseksiyonuna veya psödoanevrizmaya dönüşebileceği gibi tam rezolüsyonla da sonlanabilir. Klinik ve prognostik açıdan, tutulan aort segmentine göre proksimal (Tip A) ve distal (Tip B) akut aortik sendromlar olarak sınıflandırılır. Özellikle Tip A intramural hematomlarda cerrahi tedavi çoğu olguda önerilmektedir. Buna karşılık, desendan aortta lokalize intramural hematomlarda cerrahi ve medikal tedavi seçenekleri arasında yaşam süresi açısından belirgin fark olmadığı bildirilmektedir.

Penetran aortik ülser, aterosklerotik plağın internal elastik laminayı delerek media tabakasına ilerlemesi sonucu ortaya çıkan ülseratif bir lezyondur. Bu durum bazen stabil seyredebilirken, bazı olgularda diseksiyon veya rüptüre ilerleyerek ciddi komplikasyonlara neden olabilir. Erken tanı ve yakın takip bu hastalarda oldukça önemlidir.

Travmatik aort rüptürü veya transeksiyon ise genellikle yüksek enerjili künt göğüs travmaları sonrasında ortaya çıkar ve mortalitesi son derece yüksektir. Bu olgularda hızlı tanı ve acil cerrahi veya endovasküler girişim hayat kurtarıcıdır. Tedavi seçimi, hastanın hemodinamik stabilitesi, eşlik eden yaralanmalar ve aort lezyonunun anatomik özelliklerine göre belirlenir.

Sonuç olarak, akut aort sendromları heterojen bir klinik spektrum oluşturur ve yüksek mortalite riski taşır. Bu nedenle erken tanı, uygun görüntüleme yöntemleri ve hasta bazlı bireyselleştirilmiş tedavi yaklaşımları prognoz açısından belirleyici olmaktadır.

Anahtar Kelimeler: Akut aortik sendrom; İntramural hematom; Aort diseksiyonu; Travmatik aort rüptürü; Anevrizma

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