Reyhan AYAZ, Ateş KARATEKE, İlayda Loçlar KARAALP, Vildan NALBANT

SUPRAKORONER VE HEMİARK AORT GREFT REPLASMANI OPERASYONU GEÇİRMİŞ HASTADA GEBELİK TAKİP VE YÖNETİMİ- OLGU SUNUMU

Aort diseksiyonu nadir görülen genellikle hipertansif ve bağ doku hastalıkları ile ilişkili bir vasküler hastalık olup mortalite oranları yüksektir. Gebelikde aort diseksiyonu için bir risk faktörüdür ve tedavisi acil cerrahi müdahaledir. Gebelik sırasında aort diseksiyonuna nadiren rastlanır ve tedavisizkalması halinde ölümle sonuçlanabilir. Ancak gebelik öncesinde aort diseksiyonu geçirip opere olan ve sonra gebe kalan hastaların gebelik takibi ileilgili literatürde yeterli veri yoktur.Bu çalışmada Tip A aort diseksiyonu sonrasında suprakoroner ve hemiark aort sentetik greft replasman öyküsü olan ve 15 haftalık gebeliği sırasındatoraks bilgisayarlı tomografisinde (BT) asendan aortta aortik, anulus düzeyinde 60x56mm fuziform anevrizmatik dilatasyon, desenden aortta proksimalkesimi 55mm, orta kesim 68 mm ve distal kesimi 45mm boyutlarında belirgin fuziform anevrizma saptanmıştır. Hastanın aynı zamanda epilepsi veastım öyküsü mevcuttur.Mevcut medikal durumu ve komorbiditeleri sebebiyle kardiyoloji, kalp damar cerrahisi ve perinatolojinin içinde bulunduğu bir konsey kararı ile hastayagebeliğin yüksek riskli olduğu bildirilmiştir. Hastanın terminasyon istemi olması üzerine 3 saat aralıklarla 400 mcg vajinal prostoglandin E1uygulanmıştır. Ancak 12 saati geçmesine rağmen abortus gerçeklememesi üzerine dilatasyon amacıyla servikal balon yerleştirilmiş ve abortussonrasında rest plasenta kalması üzerine hastaya Bumm-Küretaj yapılmıştır.

PREGNANAY FOLLOW-UP AND MANAGEMENT IN A PATIENT WHO HAD UNDERGONE SUPRACORONARY AND HEMIARC AORTH GRAFT REPLACEMENT SURGERY- CASE REPORT

Aortic dissection is a rare vascular disease with high mortality rates, usually associated with hypertensive and connective tissue diseases. Pregnancy is also a risk factor for aortic dissection and its treatment is emergent surgery. Aortic dissection is rare during pregnancy and, if left untreated, it may result in death of patient. However, there is not enough data in the literature regarding the pregnancy follow-up of patients who underwent aortic dissection before pregnancy and became pregnant afterwards. In this study, it is presented that a patient with a history of supracoronary and hemiarc aortic synthetic graft replacement after Type A aortic dissection and during her 15 weeks of gestation, thorax computed tomography (CT) showed that 60x56mm fusiform aneurysmatic dilatation at the annulus level in the ascending aorta, and a distinct fusiform aneurysm with a size of 55mm at proximal section, 68mm at medial section and 45mm at distal section in the descending aorta. The patient also has a history of epilepsy and asthma. Due to the current medical condition and comorbidities, high risk pregnancy was reported to the patient with the decision of a council including cardiology, cardiovascular surgery and perinatology. When the patient requested termination, 400 mcg of vaginal prostaglandin E1 was administered at 3-hours intervals. However, the abortion did not occur after 12 hours, the cervical balloon was placed and then bumm-curettage was applied after the rest placenta remained.

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