Selçuk Nazmiye KKAPISIZ, Ertan YÜCEL, Hasan Fahri KAPISIZ

Aort koarktasyonunun cerrahi tedavisi: Rezidü hipertansiyon

Amaç: Cerrahi olarak tedavi edilen değişik yaşlardaki 11 aort koarktasyonlu hasta, eşlik eden anomaliler, cerrahi tedavi, ameliyat öncesi ve sonrası erken dönem kan basınçları açısından değerlendirildi ve bu hastalarda cerrahi tedavinin kan basıncına etkisi incelendi.Çalışma planı: Çalışmaya alınan 11 hasta (5 erkek, 6 kadın; ort. yaş 12; dağılım 1.5-27 yıl) ortalama 3 ay (1-4 ay) takip edildi. Dört hastaya rezeksiyon + uç-uca anastomoz + patent duktus arteriosus (PDA) ligasyonu, iki hastaya yama ile anjiyoplasti + PDA ligasyonu, beş hastaya yama ile anjiyoplasti uygulandı. Hastaların ortalama kan basınçları ve ekokardiyografileri ameliyat öncesi, ameliyattan sonra 1. gün, 7. gün ve 3. ayda olmak üzere incelendi.Bulgular: Hastane içi mortalite olmadı. On dört yaşından küçük altı hastanın ameliyat sonrası kan basınçlarının, 14 yaşından büyük beş hastanın ameliyat sonrası kan basınçlarından daha düşük seyrettiği görüldü. Biri 1.5, diğeri iki yaşında olan iki hasta dışında diğer tüm hastalarda ameliyat sonrası erken dönemde antihipertansif tedavi gerekti.Sonuç: Aort koarktasyonunda cerrahi tedavi altın standart olarak kabul edilmektedir. Bu hastalar erken dönemde, hipertansiyon oluşmadan teşhis edilmelidir. Aksi takdirde geç yaşlarda uygulanan cerrahi tedaviye rağmen hipertansiyon gerilemeyebilir.

Surgical treatment of aortic coarctation: residual hypertension

Background: Eleven patients with surgically treated aortic coarctation were evaluated in terms of associated anomalies, surgical therapy, preoperative and early postoperative blood pressures and the effect of surgical therapy on blood pressure was assessed.Methods: All patients (5 males, 6 females; mean age 12 years; range 1.5 to 27 years) were followed up for a mean period of 3 months (range 1 to 4 months). Resection and endto- end anastomosis + patent ductus arteriosus (PDA) ligation was applied to four patients, patchplasty + PDA ligation was applied to two patients, and patchplasty to five patients. Mean blood pressures were measured and echocardiography was performed preoperatively and on postoperative first day, 7th day and 3rd month.Results: In-hospital mortality was not observed. Postoperative blood pressures of six patients younger than 14 years of age were lower than the postoperative blood pressures of five patients who were older than 14 years of age. All patients required antihypertensive treatment except two patients who were 1.5 and 2 years old.Conclusion: Surgical treatment is the gold standard in aortic coarctation. Patients with aortic coarctation should be diagnosed in the early period before hypertension develops. Otherwise hypertension could persist despite surgical therapy in older ages.

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