{"id":2286,"date":"2025-02-16T00:00:00","date_gmt":"2025-02-15T22:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=2286"},"modified":"2026-09-24T13:15:14","modified_gmt":"2026-09-24T10:15:14","slug":"valvuler-aort-darligi","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/valvuler-aort-darligi\/","title":{"rendered":"Valv\u00fcler aort darl\u0131\u011f\u0131"},"content":{"rendered":"\t\t
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Anatomi<\/h1>

Kapak ve damar darl\u0131klar\u0131 (obstr\u00fcktif lezyonlar)<\/strong>, hemodinami\u011fi ve dolay\u0131s\u0131yla klinik bulgular\u0131 belirleyen tek veya bask\u0131n anatomik anomalinin kapak d\u00fczeyinde (bazen subvalv\u00fcler veya supravalv\u00fcler) ya da b\u00fcy\u00fck damarlar d\u00fczeyinde darl\u0131k (periferik pulmoner arter darl\u0131klar\u0131, aort koarktasyonu) oldu\u011fu konjenital kalp hastal\u0131klar\u0131d\u0131r (KKH).\"\"<\/p>

Kan ak\u0131m\u0131ndaki obstr\u00fcksiyonun \u015fiddeti de\u011fi\u015fken olabilir ve ayn\u0131 dola\u015f\u0131m sisteminin veya her iki dola\u015f\u0131m sisteminin bir ya da birden fazla b\u00f6lgesinde bulunabilir.<\/p>

Sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolunda (LVOT)<\/strong> darl\u0131k farkl\u0131 d\u00fczeylerde ortaya \u00e7\u0131kabilir. Valv\u00fcler aort darl\u0131\u011f\u0131<\/strong>, obstr\u00fcksiyonun en s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc d\u00fczeydir. Daha nadir olarak di\u011fer iki d\u00fczeyde, yani subaortik (subvalv\u00fcler)<\/strong> veya supravalv\u00fcler<\/strong> b\u00f6lgede darl\u0131k g\u00f6r\u00fcl\u00fcr.<\/p>

Sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolu obstr\u00fcksiyonunun konjenital kalp hastal\u0131klar\u0131n\u0131n yakla\u015f\u0131k %6’s\u0131n\u0131 olu\u015fturdu\u011fu ve genel pop\u00fclasyonda prevalans\u0131n\u0131n 10.000 canl\u0131 do\u011fumda 3\u20134 oldu\u011fu tahmin edilmektedir.<\/p>

Aort kapa\u011f\u0131 darl\u0131\u011f\u0131 (Ao)<\/strong><\/p>

En s\u0131k g\u00f6r\u00fclen anatomik anomali bik\u00fcspit aort kapa\u011f\u0131d\u0131r<\/strong>. Bu durum hem konjenital aort darl\u0131\u011f\u0131na hem de edinsel aort darl\u0131\u011f\u0131na yol a\u00e7abilir; ayr\u0131ca ileri ya\u015flarda geli\u015fen aort darl\u0131\u011f\u0131n\u0131n anatomik zeminini olu\u015fturabilir.<\/p>

Unik\u00fcspit aort kapa\u011f\u0131 ve aortik an\u00fcl\u00fcs hipoplazisi gibi di\u011fer aort kapa\u011f\u0131 malformasyonlar\u0131 daha nadir g\u00f6r\u00fcl\u00fcr.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Hemodinami \u2013 Yayg\u0131n Klinik Bulgular<\/h1>

A. Hemodinami<\/strong><\/p>

Kan ak\u0131m\u0131ndaki obstr\u00fcksiyonun derecesi, di\u011fer obstr\u00fcksiyon b\u00f6lgelerinin ve e\u015flik eden anatomik anomalilerin (\u00f6rne\u011fin intrakardiyak ba\u011flant\u0131lar\u0131n) bulunup bulunmamas\u0131yla birlikte hastal\u0131\u011f\u0131n \u015fiddetini belirler.<\/p>

\u00c7\u0131k\u0131\u015f kapaklar\u0131 (aort veya pulmoner kapak) d\u00fczeyindeki izole obstr\u00fcksiyon, stenotik kapaktan gerekli kan ak\u0131m\u0131n\u0131 sa\u011flayabilmek i\u00e7in gereken y\u00fcksek sistolik bas\u0131nc\u0131 olu\u015fturmak amac\u0131yla ilgili ventrik\u00fclde kompansatuvar hipertrofiye<\/strong> yol a\u00e7ar.<\/p>

Kardiyak debi, miyokard kal\u0131nl\u0131\u011f\u0131ndaki art\u0131\u015f ve bunun sonucunda artan miyokard perf\u00fczyon gereksinimi pahas\u0131na korunur (hipertrofi \u2013 olas\u0131 iskemi geli\u015fimi \u2013 fibrozis<\/strong>).<\/p>

Hipertrofik miyokard kalbin sistolik pompa fonksiyonunu koruyabilse de kompliyans\u0131 azalm\u0131\u015ft\u0131r ve bu durum diyastolik disfonksiyona<\/strong> neden olur.<\/p>

Egzersiz gibi kardiyak debi ihtiyac\u0131n\u0131n artt\u0131\u011f\u0131 durumlarda veya daha ciddi obstr\u00fcksiyonda kardiyak debi organizman\u0131n gereksinimlerini kar\u015f\u0131lamakta yetersiz kalabilir. Periferik dokular\u0131n perf\u00fczyonundaki azalma, miyokard\u0131n kendi perf\u00fczyonunun da azalmas\u0131na ve miyokard kanlanmas\u0131n\u0131n daha da bozulmas\u0131na neden olabilir.<\/p>

\u00d6zellikle fetal ya\u015fam\u0131n hassas d\u00f6neminde, azalm\u0131\u015f kardiyak debi ile kompansatuvar miyokard hipertrofisinin birlikteli\u011fi distal vask\u00fcler yap\u0131lar\u0131n hipoplazisine veya atrezisine ve miyokardda ciddi hipertrofi ile fonksiyon bozuklu\u011funa (fibroelastozis) ilerleyebilir ve sonu\u00e7ta hipoplastik sol kalp sendromu<\/strong> geli\u015febilir.<\/p>

B. Klinik bulgular<\/strong><\/p>

Obstr\u00fcksiyonun \u015fiddeti, kompansatuvar miyokard hipertrofisinin derecesini ve kardiyak debideki azalman\u0131n boyutunu belirler; bunlar da semptomlar\u0131n ortaya \u00e7\u0131k\u0131p \u00e7\u0131kmayaca\u011f\u0131n\u0131 ve \u015fiddetini belirler.<\/p>

Hafif darl\u0131klar<\/strong> genellikle semptomsuzdur (asemptomatik formlar). Kardiyak osk\u00fcltasyonda anormal bulgular\u0131n (a\u00e7\u0131lma sesi\/click, sistolik \u00fcf\u00fcr\u00fcm), di\u011fer fizik muayene bulgular\u0131n\u0131n (palpasyonda femoral arter nab\u0131zlar\u0131n\u0131n \u015fiddetinde azalma) saptanmas\u0131yla veya ba\u015fka bir nedenle yap\u0131lan ekokardiyografik inceleme s\u0131ras\u0131nda tesad\u00fcfen tan\u0131nabilir.<\/p>

Daha ciddi obstr\u00fcksiyonlar<\/strong>, yerle\u015fimlerine g\u00f6re (sistemik veya pulmoner dola\u015f\u0131m), periferik perf\u00fczyonda azalmaya yol a\u00e7abilir. Bunun sonucunda d\u00fc\u015f\u00fck sistemik kardiyak debiye ba\u011fl\u0131 bilin\u00e7 kayb\u0131, senkop, egzersiz tolerans\u0131nda azalma, akrosiyanoz ve dola\u015f\u0131m\u0131n santralizasyonu; pulmoner kan ak\u0131m\u0131ndaki azalmaya ba\u011fl\u0131 egzersiz tolerans\u0131nda azalma ve\/veya egzersiz s\u0131ras\u0131nda siyanoz; miyokard perf\u00fczyonundaki azalmaya ba\u011fl\u0131 anjina benzeri yak\u0131nmalar ve prekordiyal a\u011fr\u0131 veya pasif pulmoner konjesyona ba\u011fl\u0131 pulmoner \u00f6dem ve dispne geli\u015febilir.<\/p>

\u00c7ok ciddi obstr\u00fcksiyonlar<\/strong> veya bunlar\u0131n kombinasyonlar\u0131 yenido\u011fan d\u00f6neminde hipotansiyon ve asidoz ile kendini g\u00f6sterebilir ve ya\u015fam\u0131 tehdit edebilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Ultrasonografi<\/h1>

Hafif darl\u0131klarda<\/strong>, ultrasonografideki tek bulgu Doppler incelemesinde aliasing fenomeni<\/strong> olabilir. Buna artm\u0131\u015f ak\u0131m h\u0131z\u0131 ve baz\u0131 olgularda aortan\u0131n poststenotik dilatasyonu e\u015flik edebilir. Ya\u015f\u0131n ilerlemesiyle darl\u0131k k\u00f6t\u00fcle\u015febilir ve bulgular zamanla ciddi stenozdaki bulgulara benzer hale gelebilir.\"\"<\/p>

\u00c7\u0131kan aortan\u0131n poststenotik dilatasyonunun e\u015flik etti\u011fi hafif aort kapa\u011f\u0131 darl\u0131\u011f\u0131<\/strong><\/p>

Ciddi olgularda<\/strong>, ikinci trimesterde tipik ultrasonografik bulgu sistolik fonksiyonu bozulmu\u015f, dilate ve ekojenik bir sol ventrik\u00fcld\u00fcr. Mitral kapa\u011f\u0131n hareketleri k\u0131s\u0131tl\u0131d\u0131r; Doppler incelemesinde monofazik ak\u0131m ve mitral yetersizlik g\u00f6r\u00fclebilir.<\/p>

Foramen ovale d\u00fczeyinde ak\u0131m y\u00f6n\u00fc tersine d\u00f6nerek soldan sa\u011fa<\/strong> olur. Pulsed-wave Doppler incelemesinde kan ak\u0131m h\u0131z\u0131 artm\u0131\u015ft\u0131r (>1 m\/s).<\/p>

\u00dc\u00e7\u00fcnc\u00fc trimesterde devam eden sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolu obstr\u00fcksiyonu, sol ventrik\u00fcl boyutlar\u0131n\u0131n giderek k\u00fc\u00e7\u00fclmesiyle birlikte hipoplastik sol kalp sendromuna<\/strong> ilerleyebilir.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Tedavi<\/h1>

\u00c7ocukluk \u00e7a\u011f\u0131ndaki valv\u00fcler aort darl\u0131\u011f\u0131n\u0131n tedavisi esas olarak giri\u015fimseldir (balon valv\u00fcloplasti<\/strong>). Kapak yaprak\u00e7\u0131klar\u0131n\u0131n esnek olmas\u0131 nedeniyle bas\u0131n\u00e7 gradyan\u0131nda genellikle yeterli azalma sa\u011flanabilir.<\/p>

Cerrahi tedavi, ba\u015flang\u0131\u00e7taki hastal\u0131\u011fa ba\u011fl\u0131 olarak veya balon valv\u00fcloplastinin bir sonucu olarak \u00f6nemli aort yetersizli\u011fi geli\u015fti\u011finde uygulan\u0131r.<\/p>

Bug\u00fcne kadar elde edilen deneyimler, balon valv\u00fcloplastinin \u00e7o\u011fu olguda etkili oldu\u011funu g\u00f6stermektedir. Valv\u00fcloplasti sonras\u0131nda aort yetersizli\u011fi daha b\u00fcy\u00fck \u00e7ocuklarda (11 ya\u015f\u0131ndan b\u00fcy\u00fcklerde) daha s\u0131k g\u00f6r\u00fclmektedir.<\/p>

Balon giri\u015fiminden sonra elde edilen rezid\u00fcel bas\u0131n\u00e7 gradyan\u0131 ne kadar d\u00fc\u015f\u00fck ve komplikasyon olarak ortaya \u00e7\u0131kan aort yetersizli\u011fi ne kadar az olursa, gelecekte aort kapa\u011f\u0131 replasman\u0131 gereksinimine kadar ge\u00e7en s\u00fcre de o kadar uzun olmaktad\u0131r.<\/p>

Aort darl\u0131\u011f\u0131 olan hastalar\u0131n yo\u011fun ve yar\u0131\u015fmal\u0131 sporlardan ka\u00e7\u0131nmalar\u0131 gerekir. Ba\u015far\u0131l\u0131 balon valv\u00fcloplasti sonras\u0131nda sporla ili\u015fkili riskin azald\u0131\u011f\u0131 g\u00f6r\u00fclmektedir.<\/p>

Enfektif endokardit profilaksisine ili\u015fkin g\u00fcncel \u00f6neriler, antibiyotik profilaksisini yaln\u0131zca se\u00e7ilmi\u015f y\u00fcksek riskli durumlarda, \u00f6zellikle daha \u00f6nce enfektif endokardit ge\u00e7irmi\u015f veya protez kapa\u011f\u0131 bulunan hastalarda \u00f6nermektedir. Bu yakla\u015f\u0131m\u0131n temelinde, profilaksinin yaln\u0131zca endokardit geli\u015fme riski y\u00fcksek olanlara de\u011fil, endokardit geli\u015fmesi durumunda ciddi komplikasyon riski en y\u00fcksek olan hastalara uygulanmas\u0131 d\u00fc\u015f\u00fcncesi bulunmaktad\u0131r.<\/p>

Se\u00e7ilmi\u015f olgularda, ultrasonografide sol ventrik\u00fcl disfonksiyonu, mitral kapakta monofazik ak\u0131m, foramen ovale d\u00fczeyinde ak\u0131m\u0131n tersine d\u00f6nmesi ve duktus arteriozusta anormal\/ters ak\u0131m saptand\u0131\u011f\u0131nda prenatal d\u00f6nemde fetal kardiyak kateterizasyon ve balon aort valv\u00fcloplastisi<\/strong> uygulanabilir.<\/p>

Kritik aort darl\u0131\u011f\u0131 \u2013 Yenido\u011fan aort darl\u0131\u011f\u0131<\/h4>

Kritik aort darl\u0131\u011f\u0131<\/strong>, yenido\u011fan d\u00f6neminde ortaya \u00e7\u0131kan ve sistemik dola\u015f\u0131m\u0131n s\u00fcrd\u00fcr\u00fclebilmesi i\u00e7in duktus arteriozusun a\u00e7\u0131k kalmas\u0131na ba\u011f\u0131ml\u0131<\/strong> olacak kadar ciddi aort darl\u0131\u011f\u0131d\u0131r.<\/p>

Duktus arteriozus kapand\u0131\u011f\u0131nda yeterli sistemik kan ak\u0131m\u0131 s\u00fcrd\u00fcr\u00fclemez ve acil m\u00fcdahale yap\u0131lmad\u0131\u011f\u0131 takdirde dola\u015f\u0131m \u015foku geli\u015febilir.<\/p>

Bu nedenle b\u00f6yle bir klinik tablonun prenatal d\u00f6nemde tan\u0131nmas\u0131 son derece \u00f6nemlidir. Prenatal tan\u0131, gebenin do\u011fumdan \u00f6nce uzmanla\u015fm\u0131\u015f bir referans merkezine y\u00f6nlendirilmesini ve yenido\u011fana h\u0131zl\u0131 ve planl\u0131 m\u00fcdahale yap\u0131lmas\u0131n\u0131 sa\u011flar.<\/p>

Ciddi ancak kritik olmayan aort darl\u0131\u011f\u0131 bulunan yenido\u011fanlar kalp yetersizli\u011fi bulgular\u0131yla ba\u015fvurabilir. Bu durum son derece ciddidir ve uzmanla\u015fm\u0131\u015f bir referans merkezinde de\u011ferlendirme ve tedavi gerektirir.<\/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 Kapak ve damar darl\u0131klar\u0131 (obstr\u00fcktif lezyonlar), hemodinami\u011fi ve dolay\u0131s\u0131yla klinik bulgular\u0131 belirleyen tek veya bask\u0131n anatomik anomalinin kapak d\u00fczeyinde (bazen subvalv\u00fcler veya supravalv\u00fcler) ya da [\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-2286","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":"\nValv\u00fcler aort darl\u0131\u011f\u0131 - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"Sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolunda (LVOT) darl\u0131k farkl\u0131 d\u00fczeylerde ortaya \u00e7\u0131kabilir. Valv\u00fcler aort darl\u0131\u011f\u0131, obstr\u00fcksiyonun en s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc d\u00fczeydir. Daha nadir olarak di\u011fer iki d\u00fczeyde, yani subaortik (subvalv\u00fcler) veya supravalv\u00fcler b\u00f6lgede darl\u0131k g\u00f6r\u00fcl\u00fcr.Sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolu obstr\u00fcksiyonunun konjenital kalp hastal\u0131klar\u0131n\u0131n yakla\u015f\u0131k %6's\u0131n\u0131 olu\u015fturdu\u011fu ve genel pop\u00fclasyonda prevalans\u0131n\u0131n 10.000 canl\u0131 do\u011fumda 3\u20134 oldu\u011fu tahmin edilmektedir.\" \/>\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=\"Valv\u00fcler aort darl\u0131\u011f\u0131 - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD\" \/>\n<meta property=\"og:description\" content=\"Sol ventrik\u00fcl \u00e7\u0131k\u0131\u015f yolunda (LVOT) darl\u0131k farkl\u0131 d\u00fczeylerde ortaya \u00e7\u0131kabilir. Valv\u00fcler aort darl\u0131\u011f\u0131, obstr\u00fcksiyonun en s\u0131k g\u00f6r\u00fcld\u00fc\u011f\u00fc d\u00fczeydir. 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