Travma dışı aort rüptürüne bağlı ölümlerin değerlendirilmesi
AMAÇ: Bu çalışmanın amacı travma dışı aort rüptürü sonucu öldüğü tespit edilmiş olguların otopsi bulguları, organların his- topatolojik özellikleri, anevrizma lokalizasyonu ve risk faktörle- rini değerlendirmektir. YÖNTEM: 01.01.2015 - 31.12.2019 tarihleri arasında Adli Tıp Kurumu Morg İhtisas Dairesi tarafından travma dışı aort rüptürü nedeniyle öldüğü tespit edilen 250 vaka çalışmaya dahil edilmiş- tir. BULGULAR: Vakalardaki erkek kadın oranı 3,03: 1, yaş or- talaması 52,7±15,9’dur. Kadınların yaş ortalaması erkeklere göre anlamlı olarak daha yüksek bulunmuştur. En sık görülen yaş grubu 51-60 yaş grubu (%24,4) olarak saptanmıştır. Vaka- ların vücut kitle indeksi ortalaması 28,9±6,2 olup, kadınlarda erkeklere göre biraz daha yüksek bulunmuştur. Tıbbi özgeçmiş- lerine erişilebilen vakaların %42,8’inde hipertansiyon olduğu tespit edilmiştir. Ayrıca vakaların %50’sinde ateroskleroz olduğu görülmüştür. Bir vakada Turner Sendromu olduğu öğrenilmiş olup, vakaların %4,4’ünde de biküspit aort kapakçığı tespit edil- miştir. Anevrizmaların lokalizasyonu incelendiğinde vakaların %55,6’sında anevrizmanın assendan aortta olduğu, %10,8’inde assendan aort ve arcus aortta olduğu tespit edilmiştir. Vakaların %78’inde rüptürün assendan aortta olduğu görülmüştür. DeBa- key sınıflamasına göre vakaların %56,4’ünün Tip II, %11,6’sinin Tip I olduğu, %27,6’sının sınıflandırma dışında kaldığı tespit edil- miştir. Stanford sınıflamasına göre ise vakaların %88’inin Tip A, %8,9’unun Tip B diseksiyon olduğu, %3,1’inin ise sınıflandırma dışı kaldığı görülmüştür. SONUÇ: Travma dışı aort rüptürüne bağlı ölümlerin gerçek insidansını ve risk grubunda olan hastaları belirleyerek erken teşhis ve tedavi konusunda doğru stratejiler oluşturulması ge- rekmektedir.
Evaluation of deaths due to non-traumatic aortic rupture
INTRODUCTION: The aim of this study is to evaluate au- topsy findings, histopathological features of organs, aneurysm localization and risk factors in non-traumatic aortic rupture de- ath cases. METHODS: The data of 250 cases which determined to have died due to non-traumatic aortic rupture by the Morgue De- partment of Council of Forensic Medicine autopsy unit between 01.01.2015 and 12.31.2019 were included. RESULTS: The male-female ratio in the cases was 3.03: 1, and the mean age was 52.7±15.9 years. The mean age of wo- men was found to be significantly higher than men. The most common age group was 51-60 age group (24.4%). The mean body mass index of the cases was 28.9±6.2, and it was found to be slightly higher in women than in men. Hypertension was found in 42.8% of the cases whose medical history could be ac- cessed. In addition, 50% of the cases were found to have athe- rosclerosis. One case had Turner syndrome, and bicuspid aortic valve was detected in 4.4% of the cases. When the localization of the aneurysms was examined, 55.6% of the cases had the aneurysm in the ascending aorta, and 10.8% of the cases had in both the ascending aorta and arcus aorta. In 78% of the cases, the rupture was seen in the ascending aorta. According to the DeBakey classification, it was determined that 56.4% of the ca- ses were Type II, 11.6% were Type I, and 27.6% were excluded from the classification. According to the Stanford classification, 88% of the cases were Type A, 8.9% were Type B dissection, and 3.1% were not classified. CONCLUSION: It is necessary to establish the right strate- gies for early diagnosis and treatment by determining the real incidence of deaths due to non-traumatic aortic rupture and the patients in the risk group.
___
- 1. Şenel F. Malatya Turgut Özal Tıp Merkezi patoloji bölü- müne 2004-2005 yılları arasında gelen nedeni bilinmeyen ani ölüm vakalarının retrospektif değerlendirilmesi. İnönü Üniver- sitesi Tıp Fakültesi.2007;1-56. [in Turkish].
- 2. Temel N. Ani Ölümlerde Ateroskleroz Bulgularında Chlamydia Pneumoniae’nin Etkisinin Araştırılması, Ankara Üni- versitesi Adli Tıp Anabilim Dalı. Tıpta Uzmanlık Tezi. 2014. [in Turkish].
- 3. Basso C, Aguilera B, Banner J, Cohle S, d’Amati G, de Gouveia RH, et al. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology. Virchows Archiv. 2017;471(6):691-705.
- 4. Mendis S, Puska P, Norrving B, editors. Global at- las on cardiovascular disease prevention and control. Genava: World Health Organization (WHO); 2011.
- 5. Stecker EC, Reinier K, Marijon E, Narayanan K, Teo- dorescu C, Uy-Evanado A, et al. Public Health Burden Of Sudden Cardiac Death In The United States. Circulation: Arrhythmia and Electrophysiology. 2014;7(2):212-7.
- 6. Türkiye İstatistik Kurumu Ölüm ve Ölüm Nedeni İstatistikleri, 2019 [cited:17.04.2021] Available from: https:// data.tuik.gov.tr/Bulten/Index?p=Olum-ve-Olum-Nedeni-Istatis- tikleri-2019-33710. [in Turkish].
- 7. Soysal Z, Eke SM, Çağdır AS. Adli Otopsi Cilt III, 1999, Doğal Nedenlere Bağlı Ani Ölümler, 1129-1141 p. [in Turkish].
- 8. Sarı H, Cansunar FN, Aşırdizer M, Yavuz MS, Akistan- bullu TF. Autopsy Findings in deaths caused by aortic aneurysm rupture. Haydarpaşa Bulletin of Cardiology and Cardiovascular Surgery. 1996;4:92-96.
- 9. Erbay AK, İstanbul İlinde 2015-2019 Yılları Arasında Otopsisi Yapılmış Ateşli Silah Yaralanmasına Bağlı Ölüm Olgularının Değerlendirilmesi, Uzmanlık Tezi; 2021. [in Turkish].
- 10. Çakır H, Evaluation of Sudden Cardiac Death in Fo- rensic Autopsies Performed in Istanbul in 2019, Master Thesis; 2021.
- 11. World Health Organisation, Body Mass Index (BMI) [cited: 02.06.2021] Available from: https://www.euro.who.int/en/ health-topics/disease-prevention/nutrition/a-healthy-lifestyle/ body-mass-index-bmi.
- 12. Knight B. The Pathology of Sudden Death, Forensic Pathology Second Edition, London, 1997;504-505.
- 13. Bratzke H, Wojahn H. [The relevance of spontaneous ruptures of the aorta in forensic medicine (author’s transl)]. Z Rechtsmed. 1977 Apr;79(3):159–82.
- 14. Tüzün B, Elmas İ, Aşırdizer M, Akkay E. Evaluation of deaths due to ruptures of dissecting aorta aneurysm with re- spect to forensic medicine, İst.Tıp.Fak. Mecmuası 60:3,1997.
- 15. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD). JAMA. 2000 Feb 16;283(7):897.
- 16. Göktekin MÇ. A Retrospective Analysis of Patients With Aortic Dissection In The Emergency Unit, Van Medical Jour- nal 26(1):29-33, 2019.
- 17. Knuutinen A, Kokkonen N, Risteli J, Vähäkangas K, Kallioinen M, Salo T, et al. Smoking affects collagen synthesis and extracellular matrix turnover in human skin. Br J Dermatol. 2002 Apr;146(4):588–94.
- 18. Nordon IM, Hinchliffe RJ, Loftus IM, Thompson MM. Pathophysiology and epidemiology of abdominal aortic aneu- rysms. Nat Rev Cardiol. 2011 Feb;8(2):92–102.
- 19. Hirst AEJ, Johns VJJ, Kime SWJ. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore). 1958 Sep;37(3):217–79.
- 20. Brown LC, Powell JT. Risk factors for aneurysm rup- ture in patients kept under ultrasound surveillance. UK Small Aneurysm Trial Participants. Ann Surg. 1999 Sep;230(3):287–9.
- 21. Elefteriades JA, Olin JW, Halperin JL. Hurst’s The Heart, Chapter 106, 2261-2289 p.
- 22. Tunçer EY. Tip A Aort Diseksiyonunda 20 yıllık Koşuyolu tecrübesi. Uzmanlık Tezi; 2007. [in Turkish].
- 23. Ateş M, Akpınar MB, Okur FF, et al. Aortic Dissections and Contemporary Surgical Approaches. Turkiye Klinikleri J Cardiovasc Surg-Special Topics. 2012;4(1):18-25.
- 24. Carlson M, Silberbach M. Dissection of the aorta in Turner syndrome: two cases and review of 85 cases in the litera- ture. BMJ Case Rep. 2009;2009:bcr0620091998.
- 25. Singh K, Bønaa KH, Jacobsen BK, Bjørk L, Solberg S. Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study : The Tromsø Study. Am J Epidemiol. 2001 Aug;154(3):236–44.
- 26. Di Maio VJM, Dana SE. Handbook of Forensic Pathol- ogy, Chapter 5, 35-63 p.
- 27. Anagnostopoulos CE, Prabhakar MJS, Kittle CF. Aortic dissections and dissecting aneurysms. Am J Cardiol. 1972;30(3):263–73.
- 28. Prakash SK, Haden-Pinneri K, Milewicz DM. Sus- ceptibility to acute thoracic aortic dissections in patients dy- ing outside the hospital: an autopsy study. Am Heart J. 2011 Sep;162(3):474–9.
- 29. Albat B, Thevenet A. Dissecting aneurysms of the as- cending aorta occurring late after aortic valve replacement. J Cardiovasc Surg (Torino). 1992;33(3):272–5.
- 30. Klintschar M, Bilkenroth U, Arslan-Kirchner M, Schmidtke J, Stiller D. Marfan syndrome: clinical consequences resulting from a medicolegal autopsy of a case of sudden death due to aortic rupture. Int J Legal Med. 2009 Jan;123(1):55–8.
- 31. Bailey K, Duflou J, Puranik R. Fatal cases of aortic dis- section: an autopsy study. Vol. 158, International journal of cardi- ology. Netherlands; 2012. p. 148–9.
- 32. Rashid J, Eisenbenrg MJ, Topol EJ. Cocaine-induced aortic dissection. Am Heart J. 1996;132(6):1301-1304.
- 33. Perron AD, Gibbs M. Thoracic aortic dissection sec- ondary to crack cocaine ingestion. Am J Emerg Med. 1997 Sep;15(5):507–9.
- 34. Swalwell CI, Davis GG. Methamphetamine as a risk factor for acute aortic dissection. J Forensic Sci. 1999 Jan;44(1):23–6.
- 35. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of Acute Aortic Dissections. Ann Thorac Surg. 1970 Sep;10(3):237–47.
- 36. Raghupathy A, Nienaber CA, Harris KM, Myrmel T, Fattori R, Sechtem U, et al. Geographic differences in clinical presentation, treatment, and outcomes in type A acute aortic dissection (from the International Registry of Acute Aortic Dis- section). Am J Cardiol. 2008 Dec;102(11):1562–6.
- 37. Trimarchi S, Eagle KA, Nienaber CA, Pyeritz RE, Jonker FHW, Suzuki T, et al. Importance of refractory pain and hypertension in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circula- tion. 2010 Sep;122(13):1283–9.
- 38. Johnsen SH, Forsdahl SH, Singh K, Jacobsen BK. Ath- erosclerosis in abdominal aortic aneurysms: a causal event or a process running in parallel? The Tromsø study. Arterioscler Thromb Vasc Biol. 2010 Jun;30(6):1263–8.
- 39. Li Y, Li L, Mu H-S, Fan S-L, He F-G, Wang Z-Y. Aor- tic Dissection and Sudden Unexpected Deaths: A Retrospec- tive Study of 31 Forensic Autopsy Cases. J Forensic Sci. 2015 Sep;60(5):1206–11.