Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Aort Koarktasyonunda Balon Anjiyoplasti Sonuçlarını Etkileyen Faktörlerin Belirlenmesi
Determination of Factors Affecting the Results of Balloon Angioplasty in Coarctation of Aorta
Özlem SARISOYa, Canan AYABAKANa, Niyazi Kürşad TOKELb
aÇocuk Kardiyoloji BD, Başkent Üniversitesi İstanbul Sağlık Uygulama ve Araştırma Merkezi Hastanesi, İstanbul, TÜRKİYE
bÇocuk Kardiyoloji BD, Başkent Üniversitesi Tıp Fakültesi, Ankara, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):100-8
doi: 10.5336/cardiosci.2018-63455
Article Language: TR
Full Text
ÖZET
 Amaç: Aort koarktasyonunda balon anjiyoplastinin başarısını, sonuçlarını, rekoarktasyon sıklığını ve bunu etkileyen faktörleri saptamaktır. Gereç ve Yöntemler: Nisan 2007-Mayıs 2012 tarihleri arasında koarktasyon tanısıyla balon anjiyoplasti yapılan 53 hastanın verileri retrospektif olarak değerlendirildi. Bulgular: Ortalama yaş 14,7±35,5 (0,1-198) ay, ağırlık 7,8±8,9 kg; 23 (%43)'ü kız, 30 (%57)'u erkek hasta idi. Yaş grupları balon öncesi ve sonrası arkus ve istmus z değerleri açısından karşılaştırıldı. Balon öncesi ve sonrası, 0-3 ay (grup 1) ile 12 ay üzeri grupta arkus Z-skorları ve istmus Z-skorları, ayrıca 4-12 ay (grup 2) ile 12 ay üzeri (grup 3) grupta yine arkus aorta ve istmus Z-skorları açısından fark anlamlı bulundu. Balon öncesi sistolik basınç gradientinin ortalama 35,8±18,2 mmHg'dan, 13,8±10 mmHg'a gerilediği, koarktasyon çapının 3,3±1,9 mm'den 4,9±2,6 mm'ye arttığı görüldü. Anjiyoplasti öncesinde çıkan aorta, istmus, distal aortik arkus ve abdominal aorta çaplarının, anjiyoplasti sonrasında anlamlı olarak arttığı belirlendi. İşlem başarısı tüm hastalarda %81; 0-3 ayda %79, 4-12 ayda %77, 12 ay üzerinde ise %92 olarak bulundu. Yaş ile rekoarktasyon arasında anlamlı ilişki belirlendi. Balon öncesi istmus çapı, çıkan aorta çapının %50'si ve altında olanlarda rekoarktasyon sıklığının anlamlı düzeyde yüksek olduğu belirlendi. Komplikasyon oranı %19 olarak saptandı. Sonuç: Balon anjiyoplasti, koarktasyon tedavisinde cerrahiye alternatif ve güvenli bir tedavi yöntemidir. Balon öncesi ve sonrasında distal transvers arkus çapı ve Z-skoru, istmus çapı ve Z-skoru, koarktasyon bölgesinin çapı rekoarktasyon ile ilişkili önemli ölçümlerdir. Yaş ve ciddi istmus hipoplazisi, rekoarktasyon için anlamlı risk faktörleridir.

Anahtar Kelimeler: Aort koarktasyonu; arkus hipoplazisi; balon anjiyoplasti; istmus hipoplazisi; rekoarktasyon
ABSTRACT
 Objective: The aim of this study is to determine the factors affecting the success rate, outcome and rate of recoarctation in patients treated with balloon angioplasty for coarctation. Material and Methods: Ballon angioplasty was performed on 53 patients for coarctation of aorta between April 2007 and May 2012. The medical files of the patients were evaluated retrospectively. Results: The mean age of the patients was 14.7±35.5 months, mean weight was 7.8±8.9 kilograms. 30 were males (57%), while 23 were females (43%). The patients were classified into age groups (group 1: 0-3 months, group 2: 4-12 months, and group 3: >12 months). Arcus aorta and isthmus measurements, and their Z-scores were compared between the age groups. Between groups 1 and 3, the Z-scores of arcus and isthmus differed significantly both before and after angioplasty. Similarly the arcus and isthmus Z-scores differed significantly between groups 2 and 3. Mean systolic pressure gradient across the coarctation reduced from 35.8±18.2 to 13.8±10 mmHg. Also, the mean diameter of the coarctation segment increased from 3.3±1.9 mm to 4.9±2.6 mm. The diameters for ascending aorta, isthmus, distal aortic arch and abdominal aorta increased significantly after angioplasty as well. The overall success rate of the procedure was 81%, which increased with patient's age (79% for 0-3 months, 77% for 4-12 months, and 92% for >12 months). Younger age was significantly related with recoarctation. The frequency of recoarctation was significantly higher in patients with isthmus diameters less than or equal to 50% of ascending aorta prior to angioplasty. The rate of recoarctation for all patients was 19%. Conclusion: Balloon angioplasty is a safe alternative to surgery for aortic coarctation. Diameters and Z-scores of distal transverse arch and isthmus; and diameters of the coarctation segment both before and after ballon angioplasty may be important predictors for recoarctation. Recoarctation is anticipated more in younger age and isthmus hypoplasia.

Keywords: Coarctation of aorta; hypoplasia of arch; ballon angioplasty; isthmus hypoplasia; recoarctation
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