Ventriküler septal defekt pulmoner atrezili hastalarda anjiyografik bulguların değerlendirilmesi
Evaluati̇on of angi̇ographi̇c fi̇ndi̇ngs i̇n pati̇ents wi̇th ventri̇cular septal defect pulmonary atresi̇a
Yazar: SAVAŞ DEDEOĞLU
Danışman: DOÇ. DR. İRFAN LEVENT SALTIK
İstanbul Üniversitesi / Kardiyoloji Enstitüsü / Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı / Çocuk Kardiyolojisi Bilim Dalı
Derece: Tıpta Yan Dal Uzmanlık, 2001
Konu: Çocuk Sağlığı ve Hastalıkları = Child Health and Diseases

Özet:
VSD-PA'Lİ HASTALARIN KLİNİK VE ANJİYOGRAFİK ÖZELLİKLERİNİ, DAĞILIMLARINI DEĞERLENDİRMEK AMACIYLA OCAK 1991 VE HAZİRAN 2000 TARİHLERİ ARASINDA KATETER ANJİYOGRAFİ YAPILAN 70 VSD-PA'Lİ HASTA RETROSPEK5TİF OLARAK İNCELENDİ.
HASTALARIN 35'İ KIZ (%50), 35'İ ERKEKTİ (%50).HASTANEYE BAŞVURU TARİHİNDE EN KÜÇÜK HASTA 1 GÜNLÜK, EN BÜYÜK HASTA 11 YIL 4 AYLIK YAŞ ORTALAMASI 1,8+-2,5 YIL İDİ.HASTALAR GERÇEK VE KONFLUENT PULMONER ARTERLERİ OLUP OLMAMASINA GÖRE GRUPLANDIRILDI.BUNA GÖRE %58 HASTADA GERÇEK VE KONFLUENT PULMONER ARTERLER VARKEN, %16 HASTADA NONKONFLUENT ANCAK GERÇEK (EN AZ BİR) PULMONER ARTER SAPTANDI.HASTALARIN %26'SINDA İSE GERÇEK PULMONER ARTER GÖRÜLEMEDİ.
SİSTEMİK KOLLATERAL ARTER ORANI %76 OLARAK TESPİT EDİLDİ.PULMONER VASKÜLER ARBORİZASYONU %20 İNKOMPLET OLARAK BULDUK.DUKTUS VARLIĞI 29 HASTADA TESPİT EDİLİRKEN BU HASTALARIN SADECE %3'ÜNDE ARBORİZASYON İNKOMPLET BULUNDU.YİNE BU HASTALARIN %35'İNDE TOTAL KORREKSİYON YAPILMIŞ VE %79'UNDA PULMONER ARTERLER KONFLUENT BULUNMUŞTU.DUKTUS TESPİT EDİLEMEYEN 41 HASTANIN %32'SİNDE ARBORİZASYON İNKOMPLETTİ, BUNLARIN %17'SİNE ÜNİFOKALİZASYON YAPILMIŞTI.BU HASTALARDAN %44'ÜNDE PULMONER ARTERLER KONFLUENTTİ.
İKİ HASTAMIZDA BİLATERAL DUKTUS GÖRÜLDÜ.HASTALARIMIZIN %35'İNDE SAĞ ARKUS AORTA VARDI.4 HASTADA (%5) SOL, 3 HASTADA (%4) SAĞ ABERRAN SUBKLAVYEN ARTER TESPİT ETTİK. %25 HASTADA YÜKSEK AORTİK ARKUS MEVCUTTU.
SONUÇ OLARAK VSD-PA'Lİ HASTALARIN KLİNİK VE ANJİYOGRAFİK ÖZELLİKLERİNİN DEĞERLENDİRİLDİĞİ BU ÇALIŞMADA HASTALARIN GENİŞ BİR SPEKTRUM İÇİNDE DAĞILDIĞI GÖRÜLMÜŞTÜR.BU SPEKTRUM İÇİNDE BİRBİRİYLE BENZER KLİNİK VE MORFOLOJİK VE PROGNOSTİK ÖZELLİKLER TAŞIYAN ALT GRUPLARDA HASTALAR SINIFLANDIRILABİLİR. BU SINIFLAMAYI YAPARKEN ÖZELLİKLE ANJİYOGRAFİK OLARAK HASTALARIN AYRINTILI İNCELENMESİ GEREKİR.

Abstract:
TO EVALUATE THE CLINICAL AND ANGIOGRAPHIC FEATURES AND DISTRIBUTIONS OF PATIENTS WITH VSD-PA, 70 VSD-PA PATIENTS WERE ATTRACTED BY CATHETER ANGIOGRAPH BETWEEN JANUARY 1991 AND JUNE 2000.
35 OF THE PATIENTS WERE GIRL (50%), 35 MEN (50%). AT THE DATE OF APPLICATION TO THE HOSPITAL, THE SMALLEST PATIENT WAS 1 DAY, THE LARGEST PATIENT 11 YEARS 4 MONTHS AVERAGE AGE OF 1.8+-2.5 YEARS. PATIENTS REAL AND IT WAS GROUPED ACCORDING TO THE EXISTENCE OF CONFLUENT PULMONARY ARTERIES. ACCORDINGLY, 58% OF PATIENTS HAVE TRUE AND CONFLUENT PULMONARY ARTERIES, 16% OF PATIENTS HAVE NONCONFLUENT BUT REAL (AT LEAST ONE) PULMONARY ARTERY.
THE RATE OF SYSTEMIC COLLATERAL ARTERY WAS DETECTED AS 76%. WE FIND PULMONARY VASCULAR ARBORIZATION AS 20% INCOPLETE. THE PRESENCE OF DUCTUS WAS DETECTED IN 29 PATIENTS, AND ARBORIZATION HAS BEEN DETECTED IN ONLY 3% OF THESE PATIENTS AND IN ONLY 3% OF THESE PATIENTS, THE HARBORIZATION HAS BEEN FOUND INTOTALKOMPLETY 35%. CONFLUENT OF PULMONARY ARTERIES WAS FOUND IN SU. 32% OF THE 41 PATIENTS WITHOUT DETECTION OF THE DUCTUS HAVE ARBORIZATION INCOMPLETIC AND 17% OF THESE WERE UNIFOCALIZATION. 44% OF THESE PATIENTS WERE CONFLUENTED.
A BILATERAL DUCTUS WAS DISPLAYED IN TWO PATIENTS. 35% OF OUR PATIENTS HAD THE RIGHT ARCUS AORTA. WE DETECTED THE LEFT ARCUS AORTA IN 4 PATIENTS (5%), AND THE RIGHT ABERRANE SUBCLAVİAN ARTERY IN 3 PATIENTS (4%). 25% OF THE PATIENTS HAVE A HIGH AORTIC ARCUS.
IN CONCLUSION, IN THIS STUDY WHICH WAS EVALUATED THE CLINICAL AND ANGIOGRAPHIC FEATURES OF PATIENTS WITH VSD-PA, IT WAS OBSERVED THAT THE PATIENTS ARE DISTRIBUTED IN A WIDE SPECTRUM. THE SIGNIFICANT CLINICAL AND PORTFOLIOLOGICAL PRINCIPLE OF THE ALTHOUGHT IN THE SPECTRUM. WHILE MAKING THIS CLASSIFICATION, PATIENTS MUST BE EXAMINED IN PARTICULAR ANGIOGRAPHICALLY.