Burak Can DEPBOYLU, Buğra HARMANDAR, Kadir ARSLAN, Serkan YAZMAN

Antipsikotikler ve Antidepresanlar Aort Diseksiyonlarının Oluşumunu veya Kronikleşmesini Etkileyebilir mi?

Akut Stanford tip-A aort diseksiyonları(STAAD), aort rüptürü, ciddi aort kapak yetmezliği, perikardiyal tamponad ve serebral ve/veya koroner malperfüzyon risklerini ortadan kaldırmak için acil cerrahi gerektiren, hayatı tehdit edici hastalıklardır. Sadece küçük bir hasta alt grubu fark edilmez ve belirsiz mekanizma ile kronikleşir. Bu hastalar genellikle geç semptomlar yüzünden veya tesadüfen teşhis edilir. Kardiyopulmoner bypass ve bazen derin hipotermi ve sikülatuvar arrest gerektiren cerrahi teknikler, önemli mortalite ve komplikasyonları olan ilk basamak tedavilerdir. Burada, antipsikotik ve antidepresan tedavi alan ve total aortik ark replasmanı ile başarıyla onarılan tanısı tesadüfen konulmuş kronik STAAD hastası sunulmuştur.

Can Antipsychotics and Antidepressants Affect the Formation or Chronicization of Aortic Dissections?

Acute Stanford type-A aortic dissections (STAAD) are life-threatening diseases which require emergency surgery to eliminate risks of aortic rupture, severe aortic valve insufficiency, pericardial tamponade and cerebral and/or coronary malperfusion. Only a small subset of patients go unnoticed and become chronic with unclear mechanism. These patients are usually diagnosed thru late symptoms or incidentally. Surgical techniques requiring cardiopulmonary bypass and sometimes deep hypothermia and circulatory arrest are first-line treatments with considerable mortality and complications. Herein, an incidentally diagnosed chronic STAAD patient who was receiving antipsychotic and antidepressant treatment and successfully repaired with total aortic arch replacement was presented.

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1. Kim WK, Park SJ, Kim HJ, Kim HJ, Choo SJ, Kim JB. The fate of unrepaired chronic type A aortic dissection. J Thorac Cardiovasc Surg 2019;158:996-1004.e3.
2. Shin SW, Lee JS, Abdi S, Lee SJ, Kim KH. Antipsychotics for patients with pain. Korean J Pain 2019;32:3-11.
3. Alves BB, Oliviera GDP, Neto MGM, Fiorilli RB, Cestario EDES. Use of atypical antipsychotics and risk of hypertension: a case report and review literature. SAGE Open Med Case Rep 2019;7:1-6.
4. Falissard B, Mauri M, Shaw K, Wetterling T, Doble A, Giudicelli A, De Hert M. The METEOR study: frequency of metabolic disorders in patients with schizophrenia. Focus on first and second generation and level of risk of antipsychotic drugs. IntClinPsychopharmacol 2011;26:291-302.
5. Dania H, Barliana MI, Perwitasari DA, Abdulah R. Effect of atypical antipsychotic on blood pressure in inpatients with schizophrenia of Prof. Dr. Soerojo mental health hospital magelang. J Pharm Bioallied Sci 2019;11(Suppl 4):580-586.
6. Peterss S, Mansour AM, Ross JA, Vaitkeviciute I, Charilaou P, Dumfarth J, Fang H, Ziganshin BA, Rizzo JA, Adeniran AJ, Elefteriades JA. Changing pathology of the thoracic aorta from acute to chronic dissection: Literature review and insights. J Am Coll Cardiol 2016;68:1054-1065.