.: ORİJİNAL ARAŞTIRMA
Aort Koarktasyonunda Balon Anjiyoplasti Sonuçlarını Etkileyen Faktörlerin Belirlenmesi
Determination of Factors Affecting the Results of Balloon Angioplasty in Coarctation of Aorta
Turkiye Klinikleri J Cardiovasc Sci. 2019;31(2):100-8
doi: 10.5336/cardiosci.2018-63455
Makale Dili: TR
Tam Metin
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
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
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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