{"id":2177,"date":"2025-02-16T00:00:00","date_gmt":"2025-02-15T22:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=2177"},"modified":"2026-09-02T14:10:26","modified_gmt":"2026-09-02T11:10:26","slug":"aort-koarktasyonu","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/aort-koarktasyonu\/","title":{"rendered":"Aort Koarktasyonu"},"content":{"rendered":"\t\t
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Anatomi<\/h1>

Aort koarktasyonu (CoA), tipik olarak sol subklavyen arterin \u00e7\u0131k\u0131\u015f\u0131ndan sonra ve duktus arteriozusun aortaya ba\u011fland\u0131\u011f\u0131 b\u00f6lgeden \u00f6nce yer alan aort istmusunun daralmas\u0131d\u0131r. Bununla ili\u015fkili bir anatomik varyant, transvers aortik ark\u0131n hipoplazisidir ve prenatal d\u00f6nemde en s\u0131k saptanan anatomik bulgulardan biridir.<\/p>

\u0130zole aort koarktasyonunun s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k 10.000 canl\u0131 do\u011fumda 2’dir ve t\u00fcm konjenital kalp hastal\u0131klar\u0131n\u0131n (KKH) yakla\u015f\u0131k %7\u201310’unu olu\u015fturur.<\/p>

Klinik Bulgular<\/h1>

Klinik tablo yenido\u011fan d\u00f6nemi<\/strong> ve \u00e7ocukluk d\u00f6nemi<\/strong> olmak \u00fczere iki ana grupta de\u011ferlendirilebilir. Yenido\u011fan d\u00f6neminde hastal\u0131k, duktus arteriozusun kapanmas\u0131yla ortaya \u00e7\u0131kan kritik CoA \u015feklinde veya biraz daha ge\u00e7, genellikle ya\u015fam\u0131n ikinci haftas\u0131nda belirti verebilir. Daha ileri ya\u015flarda ise \u00e7o\u011funlukla hipertansiyon veya hipertansiyona ba\u011fl\u0131 komplikasyonlarla ortaya \u00e7\u0131kar.<\/p>

Darl\u0131k son derece \u015fiddetli ve atreziye yak\u0131n oldu\u011funda, diyafram seviyesinin alt\u0131nda kalan v\u00fccut b\u00f6lgelerine yeterli kan ak\u0131m\u0131n\u0131n sa\u011flanmas\u0131 g\u00fc\u00e7le\u015fir. Bu durumlarda alt v\u00fccut b\u00f6lgesinin kanlanmas\u0131, duktus arteriozus arac\u0131l\u0131\u011f\u0131yla sa\u011fdan sola \u015fant sayesinde sa\u011flan\u0131r. Duktus arteriozus kapand\u0131\u011f\u0131nda yenido\u011fanda dola\u015f\u0131m \u015foku ve metabolik asidoz geli\u015febilir. Bu durumda prostaglandin inf\u00fczyonu ile duktus arteriozusun yeniden a\u00e7\u0131lmas\u0131 veya a\u00e7\u0131k tutulmas\u0131 ve bebe\u011fin kesin tedavi i\u00e7in uzmanla\u015fm\u0131\u015f bir merkeze nakledilmesi gerekir.<\/p>

Darl\u0131k \u00f6nemli ancak kritik de\u011filse, duktus arteriozusun kapanmas\u0131 sol kalp dola\u015f\u0131m\u0131ndaki bas\u0131n\u00e7 y\u00fck\u00fcn\u00fc belirgin \u015fekilde art\u0131r\u0131r ve bunun sonucunda sol ventrik\u00fcl disfonksiyonu ve kalp yetmezli\u011fi geli\u015febilir. Klinik belirtiler genellikle ya\u015fam\u0131n ilk haftalar\u0131nda ve \u00e7o\u011funlukla ilk \u00fc\u00e7 ay i\u00e7inde ortaya \u00e7\u0131kar.<\/p>

Daha b\u00fcy\u00fck \u00e7ocuklarda CoA \u00e7o\u011fu zaman rutin muayene s\u0131ras\u0131nda tesad\u00fcfen saptanan hipertansiyon ve \u00fcst-alt ekstremiteler aras\u0131ndaki kan bas\u0131nc\u0131 fark\u0131 ile kendini g\u00f6sterir. Tan\u0131n\u0131n gecikmesi durumunda miyokard enfarkt\u00fcs\u00fc, inme, endokardit, aort anevrizmas\u0131 ve r\u00fcpt\u00fcr\u00fc, ba\u015f a\u011fr\u0131s\u0131, epistaksis, intermittan kladikasyon ve alt ekstremitelerde so\u011fukluk hissi gibi komplikasyonlar ortaya \u00e7\u0131kabilir.<\/p>

Fizik muayenede genellikle hipertansiyon ve \u00fcst-alt ekstremiteler aras\u0131nda kan bas\u0131nc\u0131 fark\u0131 saptan\u0131r. Femoral nab\u0131zlar al\u0131namayabilir veya zay\u0131f palpe edilebilir ve radiofemoral gecikme<\/strong> saptanabilir. Osk\u00fcltasyonda \u00fcst sol sternal kenarda ve interskapular b\u00f6lgede sistolik \u00fcf\u00fcr\u00fcm duyulabilir. Uzun s\u00fcredir devam eden olgularda geli\u015fmi\u015f kollateral dola\u015f\u0131ma ba\u011fl\u0131 ek \u00fcf\u00fcr\u00fcmler de duyulabilir. Bik\u00fcspit aort kapa\u011f\u0131 varl\u0131\u011f\u0131nda bazen ejeksiyon kli\u011fi i\u015fitilebilir. Bununla birlikte, CoA bulunan baz\u0131 hastalarda hi\u00e7bir kardiyak \u00fcf\u00fcr\u00fcm duyulmayabilece\u011fi unutulmamal\u0131d\u0131r.<\/p>

Prenatal Ultrasonografi<\/h1>

Aort koarktasyonundan, d\u00f6rt odac\u0131k g\u00f6r\u00fcnt\u00fcs\u00fcnde ventrik\u00fcller aras\u0131nda asimetri saptand\u0131\u011f\u0131nda \u015f\u00fcphelenilebilir; sa\u011f ventrik\u00fcl sol ventrik\u00fclden daha b\u00fcy\u00fck g\u00f6r\u00fcn\u00fcr. Ancak \u00e7ok a\u011f\u0131r olgular d\u0131\u015f\u0131nda sol ventrik\u00fcl genellikle kalbin apeksine kadar uzan\u0131r ve apeks olu\u015fumuna kat\u0131l\u0131r.<\/p>

\u00a0<\/p>

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Fetal kalbin d\u00f6rt odac\u0131k kesitinde sa\u011f ve sol ventrik\u00fcl aras\u0131ndaki asimetri.<\/p><\/div>

Benzer bir asimetri b\u00fcy\u00fck damarlar aras\u0131nda da g\u00f6r\u00fclebilir. Pulmoner arter ve duktus arteriozus normalin \u00fcst s\u0131n\u0131r\u0131nda veya bunun \u00fczerinde \u00f6l\u00e7\u00fclebilirken, aort normalin alt s\u0131n\u0131r\u0131n\u0131n alt\u0131nda olabilir.<\/p>

Bununla birlikte, prenatal d\u00f6nemde bu \u00f6l\u00e7\u00fcmlerin de\u011ferlendirilmesinde yanl\u0131\u015f pozitif sonu\u00e7 riski y\u00fcksektir; \u00e7\u00fcnk\u00fc a\u00e7\u0131k olan duktus arteriozus fetal hemodinamiyi de\u011fi\u015ftirerek lezyonun ger\u00e7ek \u015fiddetini maskeleyebilir.<\/p>

\u00a0<\/p>

Hipoplastik sol kalp sendromunun klasik g\u00f6r\u00fcn\u00fcm\u00fcnden farkl\u0131 olarak CoA’da hem mitral kapaktan hem de aorttan kan ak\u0131m\u0131 mevcuttur. A\u011f\u0131r koarktasyon durumunda foramen ovale d\u00fczeyinde soldan sa\u011fa \u015fant<\/strong> g\u00f6r\u00fclebilir.<\/p>

Aortik arkta retrograd kan ak\u0131m\u0131, ciddi sol kalp \u00e7\u0131k\u0131\u015f yolu obstr\u00fcksiyonunu d\u00fc\u015f\u00fcnd\u00fcr\u00fcr ve aort kapak atrezisi, a\u011f\u0131r aort stenozu veya ciddi sol ventrik\u00fcl hipoplazisi ile ili\u015fkili olabilir.<\/p>

Mitral kapa\u011f\u0131n de\u011ferlendirilmesine de \u00f6zel \u00f6nem verilmelidir. Baz\u0131 olgularda para\u015f\u00fct mitral kapak<\/strong> bulunabilir; bu durumda kapak yaprak\u00e7\u0131klar\u0131 normalde oldu\u011fu gibi iki ayr\u0131 papiller kasa de\u011fil, a\u011f\u0131rl\u0131kl\u0131 olarak tek bir papiller kasa tutunur.<\/p>

\u00a0<\/p>

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a. Normal aortik ark:<\/strong> Duktus arteriozus (sar\u0131 ok) ve aort istmusu (beyaz ok) inen aortaya ba\u011flanmaktad\u0131r.
b. <\/strong>Duktus arteriozus (k\u0131rm\u0131z\u0131 ok) ve aort istmusundaki (sar\u0131 ok) kan ak\u0131m\u0131.<\/p><\/div>

\"\"

Aortik ark\u0131n longitudinal g\u00f6r\u00fcnt\u00fcs\u00fcnde duktus arteriozus (beyaz ok) ve aort istmusunun duktus arteriozus ile birle\u015fti\u011fi b\u00f6lge (k\u0131rm\u0131z\u0131 ok); istmus \u00e7ap\u0131 inen aortaya g\u00f6re daha k\u00fc\u00e7\u00fck ve seyri daha dik olarak izlenmektedir.<\/p><\/div>

Ventrik\u00fcler septal defekt (VSD) e\u015flik etti\u011finde ventrik\u00fcller aras\u0131nda belirgin asimetri bulunmayabilir. Bu durumda asimetri yaln\u0131zca b\u00fcy\u00fck damarlar aras\u0131nda g\u00f6r\u00fclebilir ve \u00fc\u00e7 damar ve trakea (3VT) kesitinde<\/strong> fark edilebilir.<\/p>

Aortik ark\u0131n longitudinal g\u00f6r\u00fcnt\u00fcs\u00fcnde sol ortak karotis arter ile sol subklavyen arter aras\u0131ndaki mesafe normalden daha geni\u015f olabilir. Aort istmusunun duktus arteriozus ile birle\u015fti\u011fi b\u00f6lgede karakteristik bir a\u00e7\u0131lanma meydana gelebilir ve \u201cshelf\u201d (raf) g\u00f6r\u00fcn\u00fcm\u00fc<\/strong> olu\u015fabilir.<\/p>

\"\"

\u00dc\u00e7 damar ve trakea (3VT) g\u00f6r\u00fcnt\u00fcs\u00fcnde aortun (Ao) pulmoner arterden (PA) daha k\u00fc\u00e7\u00fck izlenmesi.<\/p><\/div>

Gebeli\u011fin \u00fc\u00e7\u00fcnc\u00fc trimesterinde ventrik\u00fcler asimetriye dayanarak tan\u0131 koymak daha da g\u00fc\u00e7le\u015fir; \u00e7\u00fcnk\u00fc patolojik asimetri, ileri gebelik haftalar\u0131nda fizyolojik olarak g\u00f6r\u00fclebilen sa\u011f ventrik\u00fcl bask\u0131nl\u0131\u011f\u0131ndan ay\u0131rt edilmekte zorlan\u0131labilir.<\/p>

Tedavi ve Klinik Seyir<\/h1>

Aort koarktasyonu, hipertansiyona ba\u011fl\u0131 komplikasyonlar\u0131n \u00f6nlenmesi amac\u0131yla tan\u0131 konulduktan sonra uygun zamanda tedavi edilmelidir. Tedavi edilmedi\u011finde ya\u015fam beklentisi belirgin \u015fekilde azal\u0131r; tarihsel serilerde kardiyovask\u00fcler komplikasyonlar nedeniyle ortalama ya\u015fam s\u00fcresi yakla\u015f\u0131k 35\u201340 y\u0131l olarak bildirilmi\u015ftir.<\/p>

\u00c7o\u011fu merkezde neonatal CoA tedavisinde tercih edilen y\u00f6ntem cerrahi onar\u0131md\u0131r<\/strong>. Genellikle daralm\u0131\u015f aort segmenti \u00e7\u0131kar\u0131l\u0131r ve sa\u011flam aort u\u00e7lar\u0131 birbirine anastomoz edilir.<\/p>

Belirgin sol ventrik\u00fcl disfonksiyonu varsa, kesin cerrahi onar\u0131m \u00f6ncesinde ventrik\u00fcl fonksiyonlar\u0131n\u0131n stabilizasyonu ve d\u00fczelmesi beklenebilir. Bu d\u00f6nemde medikal tedaviye ek olarak, baz\u0131 olgularda sistemik perf\u00fczyonu iyile\u015ftirmek ve sol ventrik\u00fcl\u00fcn toparlanmas\u0131na yard\u0131mc\u0131 olmak amac\u0131yla kardiyak kateterizasyon yoluyla balon dilatasyonu ge\u00e7ici bir tedavi olarak uygulanabilir.<\/p>

Daha b\u00fcy\u00fck \u00e7ocuklarda ve eri\u015fkinlerde uygun anatomik \u00f6zelliklerin bulunmas\u0131 durumunda kardiyak kateterizasyon ile balon anjiyoplasti ve stent implantasyonu<\/strong> bir\u00e7ok merkezde tercih edilen tedavi se\u00e7eneklerinden biridir. Aortik ark\u0131n uzun segment hipoplazisi mevcut oldu\u011funda ise cerrahi tedavi genellikle tercih edilir.<\/p>

Rekoarktasyon durumlar\u0131nda kardiyak kateterizasyon ve balon anjiyoplasti, gerekti\u011finde stent implantasyonu ile birlikte, genellikle tercih edilen tedavi y\u00f6ntemidir. Kateter giri\u015fimlerinin, do\u011fal aort dokusuna k\u0131yasla rekoarktasyon b\u00f6lgesindeki postoperatif skar dokusunda daha y\u00fcksek ba\u015far\u0131 oran\u0131na sahip oldu\u011fu g\u00f6r\u00fclmektedir.<\/p>

D\u00fczeltme i\u015fleminin kronik hipertansiyon geli\u015fmeden \u00f6nce yap\u0131lmas\u0131 idealdir. Uzun s\u00fcreli hipertansiyon geli\u015fmi\u015f hastalarda koarktasyon ba\u015far\u0131yla d\u00fczeltilse bile arteriyel hipertansiyon devam edebilir ve antihipertansif tedavi gerekebilir.\u00a0<\/p>

CoA hastalar\u0131n\u0131n uzun d\u00f6nem takibinde, rekoarktasyon veya aort anevrizmas\u0131n\u0131n saptanmas\u0131 ve gerekti\u011finde zaman\u0131nda m\u00fcdahale edilmesi amac\u0131yla ekokardiyografi ve manyetik rezonans g\u00f6r\u00fcnt\u00fcleme (MRG) kullan\u0131lmal\u0131d\u0131r. Hipertansiyon yaln\u0131zca egzersiz s\u0131ras\u0131nda ortaya \u00e7\u0131ksa bile de\u011ferlendirilip tedavi edilmelidir.<\/p>

Bik\u00fcspit aort kapa\u011f\u0131 bulunan hastalar, \u00e7\u0131kan aort dilatasyonu veya anevrizmas\u0131 a\u00e7\u0131s\u0131ndan da takip edilmelidir. CoA’n\u0131n Shone kompleksi<\/strong> kapsam\u0131nda bulundu\u011fu olgularda, sol kalp dola\u015f\u0131m\u0131ndaki di\u011fer obstr\u00fcktif lezyonlar da d\u00fczenli olarak de\u011ferlendirilmelidir.<\/p>

Ba\u015far\u0131l\u0131 onar\u0131m sonras\u0131nda ve istirahatte veya egzersiz s\u0131ras\u0131nda anlaml\u0131 hipertansiyon bulunmad\u0131\u011f\u0131nda, genellikle sportif aktivitelere kat\u0131l\u0131ma izin verilebilir. Ba\u015far\u0131l\u0131 \u015fekilde tedavi edilmi\u015f hastalarda gebelik de \u00e7o\u011funlukla iyi tolere edilir. Bununla birlikte, d\u00fczenli ve genellikle y\u0131ll\u0131k kardiyovask\u00fcler takip \u00f6nerilmektedir.<\/p>

\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Anatomi Aort koarktasyonu (CoA), tipik olarak sol subklavyen arterin \u00e7\u0131k\u0131\u015f\u0131ndan sonra ve duktus arteriozusun aortaya ba\u011fland\u0131\u011f\u0131 b\u00f6lgeden \u00f6nce yer alan aort istmusunun daralmas\u0131d\u0131r. Bununla ili\u015fkili bir [\u2026]<\/span><\/p>\n","protected":false},"author":3,"featured_media":-1,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[123,89,88],"tags":[],"class_list":["post-2177","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fetusun-anatomik-anomalileri-organ-sistemlerine-gore-icerik","category-kardiyak-defektler","category-konjenital-defektler"],"yoast_head":"\nAort Koarktasyonu - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"Aort koarktasyonu (CoA), tipik olarak sol subklavyen arterin \u00e7\u0131k\u0131\u015f\u0131ndan sonra ve duktus arteriozusun aortaya ba\u011fland\u0131\u011f\u0131 b\u00f6lgeden \u00f6nce yer alan aort istmusunun daralmas\u0131d\u0131r. Bununla ili\u015fkili bir anatomik varyant, transvers aortik ark\u0131n hipoplazisidir ve prenatal d\u00f6nemde en s\u0131k tan\u0131nabilen anatomik bulgulardan biridir.\u0130zole aort koarktasyonunun g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 yakla\u015f\u0131k 10.000 canl\u0131 do\u011fumda 2 olup, t\u00fcm konjenital kalp hastal\u0131klar\u0131n\u0131n (KKH) yakla\u015f\u0131k %7\u201310'unu olu\u015fturur.\" \/>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Aort Koarktasyonu - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD\" \/>\n<meta property=\"og:description\" content=\"Aort koarktasyonu (CoA), tipik olarak sol subklavyen arterin \u00e7\u0131k\u0131\u015f\u0131ndan sonra ve duktus arteriozusun aortaya ba\u011fland\u0131\u011f\u0131 b\u00f6lgeden \u00f6nce yer alan aort istmusunun daralmas\u0131d\u0131r. 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