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

Suprakoroner ve Hemiark Aort Greft Replasmanı Operasyonu Geçirmiş Hastada Gebelik Takip ve Yönetimi- Olgu Sunumu

Aort diseksiyonu nadir görülen genellikle hipertansif ve bağ doku hastalıkları ile ilişkili bir vasküler hastalık olup mortalite oranları yüksektir. Gebelik de aort diseksiyonu için bir risk faktörüdür ve tedavisi acil cerrahi müdahaledir. Gebelik sırasında aort diseksiyonuna nadiren rastlanır ve tedavisiz kalması halinde ölümle sonuçlanabilir. Ancak gebelik öncesinde aort diseksiyonu geçirip opere olan ve sonra gebe kalan hastaların gebelik takibi ile ilgili literatürde yeterli veri yoktur. Bu çalışmada Tip A aort diseksiyonu sonrasında suprakoroner ve hemiark aort sentetik greft replasman öyküsü olan ve 15 haftalık gebeliği sırasında toraks bilgisayarlı tomografisinde (BT) asendan aortta aortik, anulus düzeyinde 60x56mm fuziform anevrizmatik dilatasyon, desenden aortta proksimal kesimi 55mm, orta kesim 68 mm ve distal kesimi 45mm boyutlarında belirgin fuziform anevrizma saptanmıştır. Hastanın aynı zamanda epilepsi ve astım öyküsü mevcuttur. Mevcut medikal durumu ve komorbiditeleri sebebiyle kardiyoloji, kalp damar cerrahisi ve perinatolojinin içinde bulunduğu bir konsey kararı ile hastaya gebeliğin yüksek riskli olduğu bildirilmiştir. Hastanın terminasyon istemi olması üzerine 3 saat aralıklarla 400 mcg vajinal prostoglandin E1 uygulanmıştır. Ancak 12 saati geçmesine rağmen abortus gerçeklememesi üzerine dilatasyon amacıyla servikal balon yerleştirilmiş ve abortus sonrasında rest plasenta kalması üzerine hastaya Bumm-Küretaj yapılmıştır.

Anahtar Kelimeler:

terminasyon, aort anevrizması, gebelik

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.

Keywords:

Termination, Pregnancy, Aortic Aneurysm,

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Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and Clinicopathology of Aortic Dissection. Chest. 2000;117(5):1271-1278. doi:10.1378/chest.117.5.1271
Mandel W, Evans EW, Walford RL Dissecting aortic aneurysm during pregnancy. N Engl J Med. 1954;251(26):1059-1061 doi:10.1056/NEJM195412232512607
Yücel A, Gedik E, Özgül Ü, et al. Erken postpartum dönemde gelişen akut tip a aort diseksiyonu acil cerrahisinde anestezik yaklaşim. Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dern Derg. 2012;18(1):22-26. doi:10.5222/GKDAD.2012.022
Kamel H, Roman MJ, Pitcher A, Devereux RB. Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis. Circulation. 2016;134(7):527-533. doi:10.1161/CIRCULATIONAHA.116.021594
Lupton M, Oteng-Ntim E, Ayida G, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol. 2002;14(2):137-143. doi:10.1097/00001703-200204000-00006
Williams A, Child A, Rowntree J, Johnson P, Donnai P. Marfan’s syndrome: Successful pregnancy after aortic root and arch replacement. BJOG An Int J Obstet Gynaecol. 2002;109(10):1187-1188. doi:10.1016/S1470-0328(02)02628-9
Nasiell J, Norman M, Lindqvist PG, Malmstedt J, Bottinga R, Blennow M. Aortic dissection in pregnancy: A life-threatening disease and a diagnosis of worth considering. Acta Obstet Gynecol Scand. 2009;88(10):1167-1170. doi:10.1080/00016340903214965
Rossiter JP, Repke JT, Morales AJ, Murphy EA, Pyeritz RE. A prospective longitudinal evaluation of pregnancy in the Marfan syndrome. Am J Obstet Gynecol. 1995;173(5):1599-1606. doi:10.1016/0002-9378(95)90655-X
Whittemore R, Hobbins JC, Engle MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am J Cardiol. 1982;50(3):641-651. doi:10.1016/0002-9149(82)90334-4
Misoprostol: serious cardiovascular events, even after a single dose. Prescrire Int. 2015;24(162):183-184.
Błogowski W, Dołȩgowska B, Pikuła E, Gutowski P, Starzyńska T. The effect of PGE administration on the activity of oxidative system in erythrocytes and platelets during ischemia reperfusion injury and on postoperative renal function in patients undergoing open abdominal aortic aneurysm reconstruction. J Biol Regul Homeost Agents. 2012;26(3):429-438
Morris JL, Winikoff B, Dabash R, et al. FIGO’s updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynecol Obstet. 2017;138(3):363-366. doi:10.1002/ijgo.12181
Kayhan GE, Gülhaş N, Şahin T, et al. Gebelik Sırasında Akut Tip B Aort Diseksiyonu Gelişen Olguda Sezaryen İçin Anestezi Yaklaşımı. Turkish J Anesth Reanim. 2013:179-181. doi:10.5152/tjar.2013.27
Management of the Third Stage of Labour to Prevent Postpartum Hemorrhage. J Obstet Gynaecol Canada. 2003;25(11):952-953. doi:https://doi.org/10.1016/S1701-2163(16)30244-4
Dixon L, Abdelhafiz A. Aortic dissection. Acute Med. 2010;9(3):131.