COVID 19 Hastalarında Arcus Aorta Açısı ve Arcus Aorta Morfometrisi: Radyoanatomik bir Çalışma

Öz

Amaç: Endovasküler cerrahide Arcus Aorta morfometrisininin bilinmesi cerrahinin başarısını arttırmaktadır. Bu çalışmada COVID 19 hastalarında Arcus Aorta Açısı ve Arcus Aorta Morfometrisini inceleyip, sağlıklı bireylerle karşılaştırarak hastalığın damar üzerindeki etkisini belirlemeyi amaçlandı. Gereç ve Yöntem: Bu çalışmaya 60 COVID 19 (30 Kadın, 30 Erkek) hastası ve 60 sağlıklı (30 Kadın, 30 Erkek) birey olmak üzere toplamda 120 birey katıldı. Çalışmada arcus aorta açısı (AAA), arcus aorta çapı (AAD), arcus aorta (AA) dalları olan truncus brachiocephalicus çapı (TBD), sol a. carotis communis çapı (LACCD), sol a. subclavia çapı (ASSD), apertura torasika superior transvers (ATSD-TR) ve anteroposterior uzunluk (ATSD-AP), apertura torasika inferior transvers (ATID-TR) ve anteroposterior uzunluk (ATID-AP) parametreleri Torax Bilgisayarlı Tomografi görüntülerinden ölçüldü. Bulgular: Çalışmanın sonucunda COVID-19’lu kadın ve erkek hastalar karşılaştırıldığında ACCSD, ASSD, ATID-AP, ATID-TR değerleri erkek hastalar lehine yüksekti. COVID 19’lu kadın hastalarda kontrol grubundaki kadınlara göre Proximal AAD, TBD, ACCSD ve ASSD değerleri yüksekken; COVID 19’lu erkek hastalarda Proximal AAD, TBD, ACCSD, ASSD, ATSD-AP, ATSD-TR, ATID-AP, ATID-TR yine kontrol grubundaki erkek hastalara göre yüksekti. COVID 19 ve Kontrol grubu bireylerin ölçümlerini karşılaştırdığımızda Proximal AAD, TBD, ACCS, ASSD, ATSD-TR, ATID-AP ve ATID-TR değerleri COVID 19 hastaları lehine yüksekti. Sonuç: COVID 19 AA ve dallarının dilatasyonunu sağlayan önemli bir hastalıktır. COVID19 gibi oksijen satürasyonunu değiştiren hastalıklar aort morfolojisini değiştirebildiğini düşünüyoruz.

Anahtar Kelimeler

• COVID 19
• Arcus Aorta
• Apertura torasika superior-inferior
• morfometri
• Torax Bilgisayarlı Tomografi

Aortic Arch Angle and Aortic Arch Morphometry in COVID 19 Patients: A Radioanatomical Study

Abstract

Aim: In endovascular surgery, knowing the morphometry of the aortic arch increases the success of surgery. The aim of this study was to examine the angle and morphometry of aortic arch in COVID 19 patients and to compare these with healthy individuals to find out the effect of the disease on the vessel. Material and Methods: A total of 120 individuals - 60 COVID 19 (30 females, 30 males) patients and 60 healthy (30 females, 30 males) individuals participated in the study. In the study, the parameters of aortic arch angle (AAA), aortic arch diameter (AAD), aortic arch (AA) branches of brachiocephalic trunk diameter (BTD), left common carotid artery diameter (LCCAD), left subclavian artery diameter (LSAD), transverse superior thoracic aperture length (TR-STAL) and anteroposterior superior thoracic aperture length (AP-STAL), transverse inferior thoracic aperture length (TR-ITAL) and anteroposterior inferior thoracic aperture length (AP-ITAL) were measured from thoracic computed tomography images. Results: As a result of the study, when female and male patients with COVID-19 were compared, LCCAD, LSAD, AP-ITAL, TR-ITAL values were found to be higher in favour of male patients. While Proximal AAD, BTD, LCCAD and LSAD values were higher in female patients with COVID 19 when compared with control group female patients, Proximal AAD, BTD, LCCAD, LSAD, AP-STAL, TR-STAL, AP-ITAL, TR-ITAL values were higher in male patients with COVID 19 when compared with control group male patients. When the measurements of COVID 19 and control group individuals were compared, Proximal AAD, BTD, ACCS, LSAD, TR-STAL, AP-ITAL and TR-ITAL values were found to be higher in favour of COVID 19 patients. Conclusion: COVID 19 is an important disease that causes dilatation of the AA and its branches. We think that diseases that can change oxygen saturation such as COVID19 can change aortic morphology.

Keywords

• COVID 19
• Aortic arch
• superior-inferior thoracic aperture
• morphometry
• Thoracic computed tomography

Kaynakça

1. Arifoğlu Y. Anatomy in All Aspects 3rd edition, Türkiye, 2021.
2. Alberta H, Takayama T, Smits T, et al. Aortic arch morphology and aortic length in patients with dissection, traumatic, and aneurysmal disease. Eur J Vasc Endovasc Surg. 2015;50:754-60.
3. Shin I-Y, Chung Y-G, Shin W-H, et al. A morphometric study on cadaveric aortic arch and its major branches in 25 Korean adults: the perspective of endovascular surgery. J Korean Neurosurg Soc. 2008;44:78-83.
4. Ergun E, Şimşek B, Koşar PN, et al. Anatomical variations in branching pattern of arcus aorta: 64-slice CTA appearance. Surg Radiol Anat. 2013;35:503-9.
5. Sadeghinezhad J, Zadsar N, Bakhtiari Rad S. The anatomical investigation of the arcus aortae in persian squirrel (sciurus anomalus). Anatomical Sciences Journal. 2015;12:177-82.
6. Er Ulubaba H, Ateşoğlu Karabaş S, Çiftçi R, Yoldaş A. Investigation of pulmonary artery and ascending aorta morphology in the coronavirus disease 2019: a radioanatomical study. Thorac Res Pract. 2023;24:40-4.
7. Lee JK, Jeong HW. Wearing face masks regardless of symptoms is crucial for preventing the spread of COVID-19 in hospitals. Infect Control Hosp Epidemiol. 2021;42:115-6.
8. Çora AR, Çelik E, Karadem KB. Aortic thrombosis in the course of COVID-19 disease; two rare cases. Ann Vasc Surg. 2021;73:119-21.

9. Ateşoğlu Karabaş S, Çiftçi R, Er Ulubaba H, Yoldaş A. Investigation of subcarinal angle and tracheobronchial morphology in patients with COVID 19: a retrospective computed tomography study. Konuralp Medical Journal. 2023;15:266-72.
10. Berko NS, Jain VR, Godelman A, et al. Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr. 2009;33:523-8.
11. Aydin MM, Yalçinkaya M. Frequency of congenital aortic arch anomaly in COVID-19 patients. Rev Assoc Med Bras (1992). 2022;68:413-6.
12. Priya S, Thomas R, Nagpal P, et al. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther. 2018;8:S26-44.
13. Villines TC, Al’Aref SJ, Andreini D, et al. The journal of cardiovascular computed tomography: 2020 year in review. J Cardiovasc Comput Tomogr. 2021;15:180-9.
14. Bissacco D, Franchin M, Piffaretti G, et al. Impact of COVID-19 on aortic operations. Semin Vasc Surg. 2021;34:37-42.
15. Ardellier F-D, D’ostrevy N, Cassagnes L, et al. CT patterns of acute type A aortic arch dissection: longer, higher, more anterior. Br J Radiol. 2017;90:20170417.
16. Wang L, Hou K, Xu X, et al. A simple patient-tailored aortic arch tangential angle measuring method to achieve better clinical results for thoracic endovascular repair of type B aortic dissection. J Thorac Dis. 2018;10:2100-7.
17. Coleridge H, Coleridge J, Howe A. A search for pulmonary arterial chemoreceptors in the cat, with a comparison of the blood supply of the aortic bodies in the new&born and adult animal. J Physiol. 1967;191:353-74.
18. Honda Y. Respiratory and circulatory activities in carotid body-resected humans. J Appl Physiol (1985). 1992;73:1-8.
19. Lahiri S, Mulligan E, Nishino T, et al. Relative responses of aortic body and carotid body chemoreceptors to carboxyhemoglobinemia. J Appl Physiol Respir Environ Exerc Physiol. 1981;50:580-6.
20. Lahiri S, Nishino T, Mokashi A, Mulligan E. Relative responses of aortic body and carotid body chemoreceptors to hypotension. J Appl Physiol Respir Environ Exerc Physiol. 1980;48:781-8.
21. Pokorski M, Lahiri S. Relative peripheral and central chemosensory responses to metabolic alkalosis. Am J Physiol. 1983;245:873-80.
22. Özen KE, Çiçekcibaşi A, Aydoğdu D. Morphologic and morphometric analysis of the subclavian artery and the main branches of the subclavian artery by multidetector computerized tomography (MDCT). İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2023;8:101-10.
23. Chiles C, Davis KW, Williams DW. Navigating the thoracic inlet. Radiographics. 1999;19:1161-76.
24. Saxena AK, Alalayet YF. Surgical anatomy of the chest wall. Chest Wall Deformities. 2017:37-53.
25. Bains KNS, Kashyap S, Lappin SL. Anatomy, thorax, diaphragm. StatPearls Publishing, Treasure Island, 2018.
26. Nayak SB. Thoracic inlet or thoracic outlet: which one is which in anatomical and clinical literature?. Anat Sci Educ. 2014;7:167.