Perikardiyal tamponad kliniği ile gelen tip A aort diseksiyon olgusuna acil yaklaşım

Altmış sekiz yaşındaki erkek hasta ani başlayan göğüs ve sırt ağrısını takiben gelişen, geçici bilinç kaybı ile acil polikliniğimize başvurdu. Fizik bakıda baş ve boyun bölgesinde belirgin siyanoz, boyun ven distansiyonu bulunan hastanın ekokardiyografisinde kalp boşlukları çevresinde yoğun içerikli sıvı görüldü. Kontrastlı torakoabdominal bilgisayarlı tomografide diseksiyon lehine bulgu saptanamadı. Perikardiyal tüp drenajı ile 650 cc sıvı boşaltılan hastanın klinik durumu belirgin olarak düzeldi. Tekrarlanan ekokardiyografide çıkan aortta, kapak seviyesinden 2 cm proksimalde başlayan hipodens alanın ayırdığı çift kontur görünümü saptandı. Hasta ameliyata alındı, çıkan aorta kapak seviyesinden 2 cm proksimalden itibaren 6 cm'lik segment boyunca Dacron greft yerleştirildi ve şifa ile taburcu edildi.

Anahtar Kelimeler:

Yaşlı, Erkek, Tedavi sonucu, Aort hastalıkları, Kardiyak tamponad, Kalp cerrahi işlemleri, Ekokardiyografi

Urgent approach to a patient presenting with type A aortic dissection associated with cardiac tamponade

A male patient aged 68 years, arrived to the emergencyoutpatient clinic with a transient loss of conscience, following acute onset chest and back pain. Physical examination of the patient revealed cyanosis in the head and neck region and distension of neck veins. A dense effusion around the cardiac spaces was observed during the echocardiographic examination. Thoracoabdominal computed tomography with contrast did not reveal findings supporting dissection. The clinical condition of the patient improved significantly after the drainage of 650 ml of fluid. On repeat echocardiography, a double contour in the ascending aorta, 2 cm proximal to the valvular level and separated by a hypodense area was observed. The patient was operated and a Dacron graft was inserted to the ascending aorta along the 6 cm segment starting from 2 cm proximal to the valvular level. The patient was discharged upon full recovery.

Keywords:

Aged, Male, Treatment Outcome, Aortic Diseases, Cardiac Tamponade, Cardiac Surgical Procedures, Echocardiography,

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