Düzeltilmiş fallot tetralojili çocuklarda arteriyel sertliğin aort kökü dilatasyonu üzerine etkisinin değerlendirilmesi
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Date
2012
Authors
Melek, Hamide
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Aort kökü dilatasyonu Fallot tetralojisinin bilinen bir özelliğidir. Düzeltme amaçlı cerrahi girişimden sonra bile bazı Fallot tetralojili olgularda ilerleyici aort kökü dilatasyonu görülmektedir. Cerrahi düzeltme öncesi Fallot tetralojili hastalarda aort kökü dilatasyonu sağdan sola şantın ve dekstrapozisyonun neden olduğu aort kan akımının arttırmasına bağlanmıştır. Ayrıca erken çocukluk döneminden beri aort duvarında bulunan intrinsik histolojik anormallikler aort kök dilatasyonuna yol açan önemli bir faktördür. Bu çalışmada; düzeltme operasyonu uygulanan Fallot tetralojili olgularda aort kök dilatasyonu ile arteriyel sertlik arasındaki ilişki incelenmiştir.Düzeltme operasyonu uygulanmış Fallot tetralojili 50 olgu ve kontrol grubunu oluşturmak üzere benzer yaş dağılımına sahip 27 sağlıklı çocuk çalışmaya dahil edildi. Düzeltilmiş Fallot tetralojili olgular aort kökü dilate olanlar (grup 1) ve dilate olmayanlar (grup 2) diye iki gruba ayrıldı. Aortik strain grup 1'de, grup 2 ve kontrol grubuna göre düşük (p=0004, p<0.001), aortik distensibilite grup 1'de kontrol grubuna göre düşük (p= 0.016), beta sertlik indeksi ise yüksek bulunmuştur (p=0.016). Aortik distensibilite grup 1'de grup 2'ye göre daha düşük, beta sertlik indeksi ise daha yüksek olmakla birlikte istatistiksel olarak anlamlı bir fark saptanmamıştır (p=0.06, p=0.06). Bu sonuçlar aortun elastikiyetini gösteren aortik strainin, distensibilite ve beta sertlik indeksinden daha önce etkilenmiş olabileceğini düşündürmektedir. Arteriyel sertlik düzeltilmiş Fallot tetralojili hastalardaki ilerleyici aort kök dilatasyonundan sorumlu olabilir. Bu konunun aydınlatılması aort kökü dilatasyonu olan Fallot tetralojili olgularda tedavi yaklaşımının belirlenmesine yardımcı olacaktır.
Aortic root dilatation is a known feature in tetralogy of Fallot. Progressive aortic root dilatation has been reported in some cases with tetralogy of Fallot even after reparative surgery. Aortic root dilatation was thought to be due to increased aortic flow resulted from right to left shunting and dextraposition. Besides, intrinsic histological abnormalities of the aortic wall that presents since from infancy are important causative factors leading to aortic root dilatation. This study was conducted to explore relation of arterial stiffness with aortic root dilation in cases with repaired tetralogy of Fallot.The study population consisted of 50 cases with repaired tetralogy of Fallot and 27 age-matched healthy control children. The cases with repaired tetralogy of Fallot were divided into two groups as with and without dilated aortic root (group 1 and 2, respectively). Aortic strain was lower in group 1 than group 2 and controls (p=0004, p<0.001), aortic distensibility was lower in group 1 than controls (p= 0.016), and beta stiffness index was higher (p= 0.016). Aortic distensibility was lower and beta stiffness index was higher in group 1 compared with group 2, although statistically insignificant (p=0.06, p=0.06). These results suggested that aortic strain which indicates elasticity of the aorta may be affected earlier than the distensibility and beta stiffness index.Arterial stiffness may contribute to progressive dilation of aortic root in patients with repaired tetralogy of Fallot which. A better understanding of the pathophysiology will help to treatment strategies in tetralogy of Fallot patients with progressive aortic dilation.
Aortic root dilatation is a known feature in tetralogy of Fallot. Progressive aortic root dilatation has been reported in some cases with tetralogy of Fallot even after reparative surgery. Aortic root dilatation was thought to be due to increased aortic flow resulted from right to left shunting and dextraposition. Besides, intrinsic histological abnormalities of the aortic wall that presents since from infancy are important causative factors leading to aortic root dilatation. This study was conducted to explore relation of arterial stiffness with aortic root dilation in cases with repaired tetralogy of Fallot.The study population consisted of 50 cases with repaired tetralogy of Fallot and 27 age-matched healthy control children. The cases with repaired tetralogy of Fallot were divided into two groups as with and without dilated aortic root (group 1 and 2, respectively). Aortic strain was lower in group 1 than group 2 and controls (p=0004, p<0.001), aortic distensibility was lower in group 1 than controls (p= 0.016), and beta stiffness index was higher (p= 0.016). Aortic distensibility was lower and beta stiffness index was higher in group 1 compared with group 2, although statistically insignificant (p=0.06, p=0.06). These results suggested that aortic strain which indicates elasticity of the aorta may be affected earlier than the distensibility and beta stiffness index.Arterial stiffness may contribute to progressive dilation of aortic root in patients with repaired tetralogy of Fallot which. A better understanding of the pathophysiology will help to treatment strategies in tetralogy of Fallot patients with progressive aortic dilation.
Description
Keywords
Fallot tetralojisi, Aort kökü dilatasyonu, Arteriyel sertlik, Tetralogy of Fallot, Aortic root dilation, Arterial stiffness
Citation
Melek, H. (2012). Düzeltilmiş Fallot tetralojili çocuklarda arteriyel sertliğin aort kökü dilatasyonu üzerine etkisinin değerlendirilmesi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.