Çocuk kardiyoloji bilim dalında izlenen aort koarktasyonu tanısıyla balon anjiyoplasti uygulanan hastaların kısa ve orta dönem izlem sonuçları
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Date
2012
Authors
Hekim, Hanife
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Publisher
Uludağ Üniversitesi
Abstract
Aort koarktasyonu (AK) proksimal torasik aortanın duktusun giriş yerindeki diskret darlığıdır. AK'nın tedavisi: darlığın cerrahi olarak rezeksiyonu veya balonla genişletilmesidir. Bu çalışmada aort koarktasyonu nedeniyle balon anjiyoplasti uygulanan farklı yaş grubundaki çocuk hastalar rekoarktasyon, anevrizma, periferik arter sorunları ve eşlik eden hastalıklar yönünden değerlendirildi. Balon anjiyoplasti uygulamalarının kısa ve orta dönem izlem sonuçları değerlendirildi.Çalışmamız, 1996-2012 yılları arasında Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Kardiyolojisi Polikliniği'nden aort koarktasyonu (nativ/rekoarktasyon) nedeniyle izlenen ve BAP uygulanan 100 hastada yapıldı. Hastalar geriye dönük gözlemsel olarak değerlendirildi. Hastaların 38'i (%38) kadın, 62'si (%62) erkekti. Hasta grubunun yaş ortalaması 31±22 ay (dağılım 7 gün-18 yaş) olarak belirlendi. Hastalar anjiyoplasti anındaki yaşlarına göre Grup A (0-3 ay, n= 31, 21 erkek/10 kız), Grup B (3 ay-12 ay, n= 30, 16 erkek/14 kız) ve Grup C (>1 yaş, n= 39, 25 erkek/14 kız) olmak üzere üç gruba ayrıldı. Hastalar; nativ ve rekoarkte olmalarına göre 2 gruba ve kilolarına göre de 3 gruba ayrıldı. İstatistiksel analizlerde SPSS (Statistical package for social sciences) 16 programı kullanıldı.Olgular, işlem sonrası dönemde sol ventrikül fonksiyonları ve yeniden darlık gelişimi yönünden klinik bulgular ve transtorasik ekokardiyografi ile değerlendirildi. Bu gruplar arasında cinsiyet, izlem süresi, erken başarı, ekokardiyografik göstergeler, komplikasyonlar, eşlik eden hastalıklar açısından karşılaştırma yapıldı. Gruplar arasında cinsiyet ve izlem süresi açısından istatistiksel olarak anlamlı bir fark bulunmadı. Ortalama izlem süresi 6±4.2 yıl (dağılım 3 ay-15 yıl) idi. Balon anjiyoplasti yapılan 87 (%87)'si nativ, 13 (%13)'ü rekoarktasyonlu 100 hastanın; tepe sistolik basınç farkları 43.56±18,5 mmHg'dan 13.2±10 mmHg'ya geriledi (p<0.001). Onaltı olguda balon anjiyoplasti ile darlık bölgesinde yeterli basınç farkı azalışı sağlanamadı. İşlem sonu erken başarı açısından gruplar arasında fark yoktu. Hastaların 29 (%29)'unda rekoarktasyon gelişirken [16 (%51)'sı Grup A, 9 (%30)'u Grup B ve 4 (%10)'ü Grup C], sıklık 0-3 ay grubunda daha fazlaydı (p=0.001). İzlemde beş olguda femoral arter oklüzyonu, üç olguda anevrizma oluşumu görüldü. Beraberinde 57 (%57)'sinde bikuspit aorta, 26 (%26)'sında atrial septal defekt, 24 (%24)'ünde aort stenozu, 22 (%22)'sinde ventriküler septal defekt, 22 (%22)'sinde patent duktus arteriyozus olan hastaların 2'sinde Turner sendromu vardı.Balon anjiyoplasti nativ ve postoperatif gelişen aort koarktasyonunda darlıkların tedavisinde bir yöntem olarak kullanılabilir. Aort koarktasyonu tedavisinde balon anjiyoplasti kısa ve orta dönem sonuçları açısından başarılı ve güvenilir bir yöntemdir. Özellikle 3 ay ve altındaki çocuklar işlem sonrası rekoarktasyon, anevrizma ve periferik arter problemleri açısından yakın izlenmelidir.
Coarctation of the aorta is discrete narrowing in the entrance of ductus at the proximal thoracic aorta. Repair of the coarctation of aorta are surgical resection or balloon dilatation of the coarctation are two main methods of treatment. Pediatric patients with different age groups who underwent balloon angioplasty for aortic coarctation were evaluated for recoarctation, aneurysm, peripheral arterial injuries and concomitant diseases. We evaluated short- and mid-term results of balloon angioplasty .Our research was performed on 100 patients who had been followed and underwent balloon angioplasty at Uludag University, Faculty of Medicine, Department of Pediatric Cardiology, due to aort coarctation (native/recoarctation). Patients were evaluated, retrospectively. 38 (38%) were female, 62 (62%) were male. Mean age of the patient group was 31±22 months (range 7 days to 18 years). According to age at angioplasty, patients were divided into three groups: Group A (0-3 months, n=31, 21 male/10 female), Group B (3-12 months, n=30, 16 male/14 girls) and Group C (> 1 year, n= 39, 25 male/14 girls). Patients were also divided into two groups as native and recoarcted patients and three groups as their weights. SPSS (Statistical package for social sciences) 16 was used for statistical analyses.The patients were assessed by clinical signs and transthoracic echocardiography for left ventricular functions and recoarctation. A comparison was made between these groups based on sex, follow-up period, early success, echocardiography parameters, complications, associated defects. Mean follow-up period was 6±4.2 years (range 3 months to 15 years). Between these groups, no statistical significant difference in terms of sex and follow-up period was found. Peak systolic pressure gradient was reduced from 43.56±18,5 mmHg to 13.2±10 mmHg after balloon angioplasty (p<0.001) [n=100, 87 (87%) native, 13 (13%) recoarctation]. Decrease in the gradients was not sufficient in sixteen cases. There was no difference between groups for early success. While recoarctation developed in 29 (29%), [16 (51%) in Group A, 9 (30%) in Group B and 4 (10%) in group C] incidence was higher in the 0-3 months age group (p=0.001). During the follow-up period, femoral artery occlusion was seen in five cases, and a aneurysmal formation in three case. There were bicuspid aorta in 57 (57%), atrial septal defect in 26 (26%), aortic stenosis in 24 (24%), ventricular septal defect in 22 (22%), patent ductus arteriosus in 22 (22%) patients. Two patients had Turners syndrome.Balloon angioplasty can be used a method in treatment of native aortic coarctation and postoperative restenosis. Considering its short- and mid-term results, balloon angioplasty is a successful and reliable procedure in the treatment of aortic coarctation. Especially, children under 3 months should be monitored closely after the procedure for recoarctation, aneurysms and peripheral artery problems.
Coarctation of the aorta is discrete narrowing in the entrance of ductus at the proximal thoracic aorta. Repair of the coarctation of aorta are surgical resection or balloon dilatation of the coarctation are two main methods of treatment. Pediatric patients with different age groups who underwent balloon angioplasty for aortic coarctation were evaluated for recoarctation, aneurysm, peripheral arterial injuries and concomitant diseases. We evaluated short- and mid-term results of balloon angioplasty .Our research was performed on 100 patients who had been followed and underwent balloon angioplasty at Uludag University, Faculty of Medicine, Department of Pediatric Cardiology, due to aort coarctation (native/recoarctation). Patients were evaluated, retrospectively. 38 (38%) were female, 62 (62%) were male. Mean age of the patient group was 31±22 months (range 7 days to 18 years). According to age at angioplasty, patients were divided into three groups: Group A (0-3 months, n=31, 21 male/10 female), Group B (3-12 months, n=30, 16 male/14 girls) and Group C (> 1 year, n= 39, 25 male/14 girls). Patients were also divided into two groups as native and recoarcted patients and three groups as their weights. SPSS (Statistical package for social sciences) 16 was used for statistical analyses.The patients were assessed by clinical signs and transthoracic echocardiography for left ventricular functions and recoarctation. A comparison was made between these groups based on sex, follow-up period, early success, echocardiography parameters, complications, associated defects. Mean follow-up period was 6±4.2 years (range 3 months to 15 years). Between these groups, no statistical significant difference in terms of sex and follow-up period was found. Peak systolic pressure gradient was reduced from 43.56±18,5 mmHg to 13.2±10 mmHg after balloon angioplasty (p<0.001) [n=100, 87 (87%) native, 13 (13%) recoarctation]. Decrease in the gradients was not sufficient in sixteen cases. There was no difference between groups for early success. While recoarctation developed in 29 (29%), [16 (51%) in Group A, 9 (30%) in Group B and 4 (10%) in group C] incidence was higher in the 0-3 months age group (p=0.001). During the follow-up period, femoral artery occlusion was seen in five cases, and a aneurysmal formation in three case. There were bicuspid aorta in 57 (57%), atrial septal defect in 26 (26%), aortic stenosis in 24 (24%), ventricular septal defect in 22 (22%), patent ductus arteriosus in 22 (22%) patients. Two patients had Turners syndrome.Balloon angioplasty can be used a method in treatment of native aortic coarctation and postoperative restenosis. Considering its short- and mid-term results, balloon angioplasty is a successful and reliable procedure in the treatment of aortic coarctation. Especially, children under 3 months should be monitored closely after the procedure for recoarctation, aneurysms and peripheral artery problems.
Description
Keywords
Aort koarktasyonu, Balon anjiyoplasti, Rekoarktasyon, Çocuk, Aortic coarctation, Balloon angioplasty, Recoarctation, Children
Citation
Hekim, H. (2012). Çocuk kardiyoloji bilim dalında izlenen aort koarktasyonu tanısıyla balon anjiyoplasti uygulanan hastaların kısa ve orta dönem izlem sonuçları. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.