TRAVMATÝK AORT RÜPTÜRÜ: TANI VE TEDAVÝ YÖNTEMLERÝ

Travmatik aort rüptürleri nadir tanýnan, taný ve tedavi aþamasýnda kardiyotorasik cerrahlara çeþitli güçlükler çýkaran lezyonlardýr. Bu klinik antitenin tartýþmalý yönlerini klinik deneyimlerimiz ve aort tamirinde kullandýðýmýz deðiþik bypass teknikleri açýsýndan irdeledik. Kliniðimizde 1996 ile 1999 yýllarý arasýnda 6 hasta travmatik aort rüptürü tanýsýyla tedavi edilmiþtir. Dört hastada kronik rüptür mevcut iken 2 hasta akut dönemde kliniðimize baþvurmuþtur. Hastalarýn tümünde hastaneye geldiklerinde çekilen göðüs grafilerinde patolojik bulgular saptanmýþtýr. Tüm hastalarda desendan aortaya greft interpozisyonu uygulanmýþtýr. Dört hastada tamir total derin hipotermik sirkulatuvar arrest altýnda uygulanmýþtýr. Bir hastada aort tamiri kross-klemp altýnda yapýlýrken, bir diðer hastada ise parsiyel sol atrio-femoral bypass altýnda tamir gerçekleþtirilmiþtir. Operatif veya postoperatif mortalite olmamýþtýr. Hiçbir hastada parapleji/paraparezi gözlenmemiþtir. Hastalar 5. ve 13. postoperatif günler arasýnda taburcu edilmiþtir (ortalama 10.7 3.6 gün). Postoperatif takip dönemi 2 ay ile 42 ay arasýnda olup hastalarýn tümü hayattadýr. Kontrol göðüs grafîlerinde veya bilgisayarlý tomografi tetkiklerinde bir patoloji yada rekürrent anevrizma tespit edilmemiþtir. Travmatik aort rüptürlerinin cerrahi tedavisinde atrio-femoral bypass veya total hipotermik sirkulatuvar arrest gibi tekniklerin uygulanmasýnýn baþlýca anevrizmanýn lokalizasyonuna ve büyüklüðüne baðlý olduðunu söyleyebiliriz. Bu nedenle hastanýn klinik durumuna göre operatif tedavi tekniðinin belirlenmesi gerekmektedir.

TRAUMATIC AORTIC RUPTURE: DIAGNOSIS AND MANAGEMENT

Traumatic aortic rupture is a relatively uncommon lesion that presents the cardiothoracic surgeon with unique challenges in diagnosis and management. To address controversial aspect of this disease, we reviewed our experience to evaluate outcome and to outline critical technical aspects of bypass management and aortic repair. Six patients with traumatic thoracic aortic rupture were managed between 1996-1999. Four patients had chronic, the other two had acute traumatic thoracic aortic rupture. In all patients chest X-ray findings were abnormal. In all patients graft interposition was performed. In four patients repair were performed under total hypothermic circulatory arrest. In one patient repair was performed with simple aortic cross-clamping and in the remaining patient repair was performed with partial left atrio-femoral bypass. There was no perioperative or postoperative mortality. Paraplegy orparaparesia was not seen. Patients were dischargedfrom hospital between postoperative day Sand 13 (mean 10.7 3.6days). All patients are still alive at follow-up periods between 2 months to 42 months. Serial chest X-rays and computed tomographies showed no evidence of any pathology or recurrent aneurysm in any patient. Management options for surgical technique and bypass including left atrio-femoral or venoarterial bypass with total hypothermic circulatory arrest are mainly dependent location and extension of aneurysm and patient physical condition. Therefore, the decision should be tailored to the specific clinical situation.