Aort Diseksiyonu
Özet
Aort diseksiyonu, aortun intimal tabakasındaki yırtık veya aort duvarındaki kanama sonucu aort duvarının farklı tabakalarının ayrılması sonucu gelişen yaşamı tehdit eden bir durumdur. Hastalar; göğüs ağrısı, ka- rın-sırt ağrısı, kalp yetersizliği, kardiyak tamponad, miyokardiyal iskemi-infarkt, plevral efüzyon, nöro- lojik bulgular,alt ekstremite iskemisi, barsak iskemisi, akut böbrek yetmezliği ile başvurabilir. Transtorasik ekokardiyografi, transözefageal ekokardiyografi, kontrastlı BT, MRG ile tanı konur. Tedavi edilmezse 2 hafta içerisinde mortalite %75, cerrahi tedavi ile 5 yıllık sağkalım %75’tir. Tip A diseksiyonun tedavisi cerahidir. Tip B aort diseksiyonu; medikal, torasik endovasküler onarım (TEVAR) veya cerahi olarak te- davi edilebilir.
Aortic dissection, tear in the intimal layer of the aorta or damage to the aortic wall as a result of bleeding in the aortic wall life developed as a result of the separation of different layers It is a threatening situation. Patients; chest pain, back pain, heart failure, cardiac tamponade, myocardial ischemia-infarction, pleural effusion, neuro-logical findings, lower extremity ischemia, intestinal ischemia, may present with acute renal failure.
Diagnosis is made by Transtorasic echocardiography, transesophageal echocardiography, contrast-enhanced CT and MRI. If left untreated Mortality is 75% within 2 weeks, 5 months with surgical treatment annual survival is 75%. Treatment of type A dissection It is surgical. Type B aortic dissection; medical, thoracic endovascular repair (TEVAR) or surgical treatment can be dealt with.
Referanslar
KERZMANN A, HAUMANN A, BOESMANS E, DETRY O, Defraigne J-O. L'ischemie mesenterique aigue. Revue Médicale de Liège. 2018;73(5-6).
AUH NHA, Eifer J, RH PSO. ESC Guidelines.
Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation. 1999;99(10):1331-6.
Sievers H-H, Rylski B, Czerny M, Baier AL, Kreibich M, Siepe M, et al. Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction. Interactive cardiovascular and thoracic surgery. 2020;30(3):451-7.
Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031-7.
Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14 000 cases from 1987 to 2002. Circulation. 2006;114(24):2611-8.
Januzzi JL, Eagle KA, Cooper JV, Fang J, Sechtem U, Myrmel T, et al. Acute aortic dissection presenting with congestive heart failure: results from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. 2005;46(4):733-5.
Moro H, Hayashi J-i, Sogawa M. Surgical management of the ruptured aortic arch. The Annals of thoracic surgery. 1999;67(2):593-4.
Trimarchi S, Tolenaar J, Tsai T, Froehlich J, Pegorer M, Upchurch G, et al. Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD. The Journal of cardiovascular surgery. 2012;53(2):161-8.
Klompas M. Does this patient have an acute thoracic aortic dissection? Jama. 2002;287(17):2262-72.
Jex RK, Schaff HV, Piehler JM, Orszulak TA, Puga FJ, King RM, et al. Repair of ascending aortic dissection: influence of associated aortic valve insufficiency on early and late results. The Journal of Thoracic and Cardiovascular Surgery. 1987;93(3):375-84.
Erbel R, Oelert H, Meyer J, Puth M, Mohr-Katoly S, Hausmann D, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation. 1993;87(5):1604-15.
Gilon D, Mehta RH, Oh JK, Januzzi Jr JL, Bossone E, Cooper JV, et al. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. The American journal of cardiology. 2009;103(7):1029-31.
Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. The Journal of thoracic and cardiovascular surgery. 2013;145(2):385-90. e1.
Jánosi RA, Buck T, Erbel R. Mechanism of coronary malperfusion due to type-a aortic dissection. Herz. 2009;34(6):478.
LeMaire SA, Jones MM, Conklin LD, Carter SA, Criddell MD, Wang XL, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery. 2009;49(1):11-9.
Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013;128(11_suppl_1):S175-S9.
Mintz GS, Kotler MN, Segal BL, Parry WR. Two dimensional echocardiographic recognition of the descending thoracic aorta. The American Journal of Cardiology. 1979;44(2):232-8.
Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller Jr FA, Stanson AW, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. Journal of the American Society of Echocardiography. 1989;2(1):17-24.
Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography. European Heart Journal. 1984;5(7):545-55.
Erbel R, Daniel W, Visser C, Engberding R, Roelandt J, Rennollet H. Echocardiography in diagnosis of aortic dissection. The Lancet. 1989;333(8636):457-61.
Demos TC, Posniak HV, Churchill RJ. Detection of the intimal flap of aortic dissection on unenhanced CT images. American journal of roentgenology. 1986;146(3):601-3.
Rubin GD, Beaulieu CF, Argiro V, Ringl H, Norbash AM, Feller JF, et al. Perspective volume rendering of CT and MR images: applications for endoscopic imaging. Radiology. 1996;199(2):321-30.
Garzón G, Fernández-Velilla M, Martí M, Acitores I, Ybáñez F, Riera L. Endovascular stent-graft treatment of thoracic aortic disease. Radiographics. 2005;25(suppl_1):S229-S44.
Sommer T, Fehske W, Holzknecht N, Smekal AV, Keller E, Lutterbey G, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology. 1996;199(2):347-52.
Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in emergency radiology. Radiology. 1999;213(2):321-39.
Kucich V, Vogelzang RL, Hartz R, LoCicero 3rd J, Dalton D. Ruptured thoracic aneurysm: unusual manifestation and early diagnosis using CT. Radiology. 1986;160(1):87-9.
Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. New England Journal of Medicine. 1993;328(1):1-9.
Deutsch HJ, Sechtem U, Meyer H, Theissen P, Schicha H, Erdmann E. Chronic aortic dissection: comparison of MR Imaging and transesophageal echocardiography. Radiology. 1994;192(3):645-50.
Chiappini B, Schepens M, Tan E, Amore AD, Morshuis W, Dossche K, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. European heart journal. 2005;26(2):180-6.
Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. The Journal of thoracic and cardiovascular surgery. 2005;129(1):112-22.
Perko MJ, Nørgaard M, Herzog TM, Olsen PS, Schroeder TV, Pettersson G. Unoperated aortic aneurysm: a survey of 170 patients. The Annals of thoracic surgery. 1995;59(5):1204-9.
Referanslar
KERZMANN A, HAUMANN A, BOESMANS E, DETRY O, Defraigne J-O. L'ischemie mesenterique aigue. Revue Médicale de Liège. 2018;73(5-6).
AUH NHA, Eifer J, RH PSO. ESC Guidelines.
Svensson LG, Labib SB, Eisenhauer AC, Butterly JR. Intimal tear without hematoma: an important variant of aortic dissection that can elude current imaging techniques. Circulation. 1999;99(10):1331-6.
Sievers H-H, Rylski B, Czerny M, Baier AL, Kreibich M, Siepe M, et al. Aortic dissection reconsidered: type, entry site, malperfusion classification adding clarity and enabling outcome prediction. Interactive cardiovascular and thoracic surgery. 2020;30(3):451-7.
Howard DP, Banerjee A, Fairhead JF, Perkins J, Silver LE, Rothwell PM. Population-based study of incidence and outcome of acute aortic dissection and premorbid risk factor control: 10-year results from the Oxford Vascular Study. Circulation. 2013;127(20):2031-7.
Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14 000 cases from 1987 to 2002. Circulation. 2006;114(24):2611-8.
Januzzi JL, Eagle KA, Cooper JV, Fang J, Sechtem U, Myrmel T, et al. Acute aortic dissection presenting with congestive heart failure: results from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. 2005;46(4):733-5.
Moro H, Hayashi J-i, Sogawa M. Surgical management of the ruptured aortic arch. The Annals of thoracic surgery. 1999;67(2):593-4.
Trimarchi S, Tolenaar J, Tsai T, Froehlich J, Pegorer M, Upchurch G, et al. Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD. The Journal of cardiovascular surgery. 2012;53(2):161-8.
Klompas M. Does this patient have an acute thoracic aortic dissection? Jama. 2002;287(17):2262-72.
Jex RK, Schaff HV, Piehler JM, Orszulak TA, Puga FJ, King RM, et al. Repair of ascending aortic dissection: influence of associated aortic valve insufficiency on early and late results. The Journal of Thoracic and Cardiovascular Surgery. 1987;93(3):375-84.
Erbel R, Oelert H, Meyer J, Puth M, Mohr-Katoly S, Hausmann D, et al. Effect of medical and surgical therapy on aortic dissection evaluated by transesophageal echocardiography. Implications for prognosis and therapy. The European Cooperative Study Group on Echocardiography. Circulation. 1993;87(5):1604-15.
Gilon D, Mehta RH, Oh JK, Januzzi Jr JL, Bossone E, Cooper JV, et al. Characteristics and in-hospital outcomes of patients with cardiac tamponade complicating type A acute aortic dissection. The American journal of cardiology. 2009;103(7):1029-31.
Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. The Journal of thoracic and cardiovascular surgery. 2013;145(2):385-90. e1.
Jánosi RA, Buck T, Erbel R. Mechanism of coronary malperfusion due to type-a aortic dissection. Herz. 2009;34(6):478.
LeMaire SA, Jones MM, Conklin LD, Carter SA, Criddell MD, Wang XL, et al. Randomized comparison of cold blood and cold crystalloid renal perfusion for renal protection during thoracoabdominal aortic aneurysm repair. Journal of Vascular Surgery. 2009;49(1):11-9.
Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013;128(11_suppl_1):S175-S9.
Mintz GS, Kotler MN, Segal BL, Parry WR. Two dimensional echocardiographic recognition of the descending thoracic aorta. The American Journal of Cardiology. 1979;44(2):232-8.
Khandheria BK, Tajik AJ, Taylor CL, Safford RE, Miller Jr FA, Stanson AW, et al. Aortic dissection: review of value and limitations of two-dimensional echocardiography in a six-year experience. Journal of the American Society of Echocardiography. 1989;2(1):17-24.
Iliceto S, Ettorre G, Francioso G, Antonelli G, Biasco G, Rizzon P. Diagnosis of aneurysm of the thoracic aorta. Comparison between two non invasive techniques: two-dimensional echocardiography and computed tomography. European Heart Journal. 1984;5(7):545-55.
Erbel R, Daniel W, Visser C, Engberding R, Roelandt J, Rennollet H. Echocardiography in diagnosis of aortic dissection. The Lancet. 1989;333(8636):457-61.
Demos TC, Posniak HV, Churchill RJ. Detection of the intimal flap of aortic dissection on unenhanced CT images. American journal of roentgenology. 1986;146(3):601-3.
Rubin GD, Beaulieu CF, Argiro V, Ringl H, Norbash AM, Feller JF, et al. Perspective volume rendering of CT and MR images: applications for endoscopic imaging. Radiology. 1996;199(2):321-30.
Garzón G, Fernández-Velilla M, Martí M, Acitores I, Ybáñez F, Riera L. Endovascular stent-graft treatment of thoracic aortic disease. Radiographics. 2005;25(suppl_1):S229-S44.
Sommer T, Fehske W, Holzknecht N, Smekal AV, Keller E, Lutterbey G, et al. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology. 1996;199(2):347-52.
Novelline RA, Rhea JT, Rao PM, Stuk JL. Helical CT in emergency radiology. Radiology. 1999;213(2):321-39.
Kucich V, Vogelzang RL, Hartz R, LoCicero 3rd J, Dalton D. Ruptured thoracic aneurysm: unusual manifestation and early diagnosis using CT. Radiology. 1986;160(1):87-9.
Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. New England Journal of Medicine. 1993;328(1):1-9.
Deutsch HJ, Sechtem U, Meyer H, Theissen P, Schicha H, Erdmann E. Chronic aortic dissection: comparison of MR Imaging and transesophageal echocardiography. Radiology. 1994;192(3):645-50.
Chiappini B, Schepens M, Tan E, Amore AD, Morshuis W, Dossche K, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. European heart journal. 2005;26(2):180-6.
Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. The Journal of thoracic and cardiovascular surgery. 2005;129(1):112-22.
Perko MJ, Nørgaard M, Herzog TM, Olsen PS, Schroeder TV, Pettersson G. Unoperated aortic aneurysm: a survey of 170 patients. The Annals of thoracic surgery. 1995;59(5):1204-9.
