Suprakoroner ve Hemiark Aort Greft Replasmanı Operasyonu Geçirmiş Hastada Gebelik Takip ve Yönetimi- Olgu Sunumu

Abstract

Aort diseksiyonu nadir görülen genellikle hipertansif ve bağ doku hastalıkları ile ilişkili bir vasküler hastalık olup mortalite oranları yüksektir. Gebelik de aort diseksiyonu için bir risk faktörüdür ve tedavisi acil cerrahi müdahaledir. Gebelik sırasında aort diseksiyonuna nadiren rastlanır ve tedavisiz kalması halinde ölümle sonuçlanabilir. Ancak gebelik öncesinde aort diseksiyonu geçirip opere olan ve sonra gebe kalan hastaların gebelik takibi ile ilgili literatürde yeterli veri yoktur. Bu çalışmada Tip A aort diseksiyonu sonrasında suprakoroner ve hemiark aort sentetik greft replasman öyküsü olan ve 15 haftalık gebeliği sırasında toraks bilgisayarlı tomografisinde (BT) asendan aortta aortik, anulus düzeyinde 60x56mm fuziform anevrizmatik dilatasyon, desenden aortta proksimal kesimi 55mm, orta kesim 68 mm ve distal kesimi 45mm boyutlarında belirgin fuziform anevrizma saptanmıştır. Hastanın aynı zamanda epilepsi ve astım öyküsü mevcuttur. Mevcut medikal durumu ve komorbiditeleri sebebiyle kardiyoloji, kalp damar cerrahisi ve perinatolojinin içinde bulunduğu bir konsey kararı ile hastaya gebeliğin yüksek riskli olduğu bildirilmiştir. Hastanın terminasyon istemi olması üzerine 3 saat aralıklarla 400 mcg vajinal prostoglandin E1 uygulanmıştır. Ancak 12 saati geçmesine rağmen abortus gerçeklememesi üzerine dilatasyon amacıyla servikal balon yerleştirilmiş ve abortus sonrasında rest plasenta kalması üzerine hastaya Bumm-Küretaj yapılmıştır.

Keywords

• terminasyon
• aort anevrizması
• gebelik

Pregnanay Follow-Up and Management in a Patient Who Had Undergone Supracoronary and Hemiarc Aorth Graft Replacement Surgery- Case Report

Abstract

Aortic dissection is a rare vascular disease with high mortality rates, usually associated with hypertensive and connective tissue diseases. Pregnancy is also a risk factor for aortic dissection and its treatment is emergent surgery. Aortic dissection is rare during pregnancy and, if left untreated, it may result in death of patient. However, there is not enough data in the literature regarding the pregnancy follow-up of patients who underwent aortic dissection before pregnancy and became pregnant afterwards. In this study, it is presented that a patient with a history of supracoronary and hemiarc aortic synthetic graft replacement after Type A aortic dissection and during her 15 weeks of gestation, thorax computed tomography (CT) showed that 60x56mm fusiform aneurysmatic dilatation at the annulus level in the ascending aorta, and a distinct fusiform aneurysm with a size of 55mm at proximal section, 68mm at medial section and 45mm at distal section in the descending aorta. The patient also has a history of epilepsy and asthma. Due to the current medical condition and comorbidities, high risk pregnancy was reported to the patient with the decision of a council including cardiology, cardiovascular surgery and perinatology. When the patient requested termination, 400 mcg of vaginal prostaglandin E1 was administered at 3-hours intervals. However, the abortion did not occur after 12 hours, the cervical balloon was placed and then bumm-curettage was applied after the rest placenta remained.

Keywords

• Termination
• Pregnancy
• Aortic Aneurysm

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