Kirurgija aorte kod Stanford A disekcije

master's thesis

• Title (english): Aortic surgery in Stanford A dissection
• Author: Luka Ostojić
• Mentor: Igor Rudež (mentor)
• Committee member: Joško Bulum (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Igor Rudež (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2021-09-02, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Aorta je početna i najveća arterija ljudskog tijela koja dovodi krv bogatu kisikom u sve dijelove tijela. Razvoj aorte započinje u 3. tjednu gestacije. Aortalni zid se sastoji od unutarnjeg, srednjeg i vanjskog sloja. Disekcija aorte nastaje kao posljedica razdora
unutarnjeg sloja i prodora krvi između unutrašnjeg i srednjeg sloja, pri čemu dolazi do njihovog razdvajanja. Tip A disekcija nastaje kada se razdor dogodi u ascendentnom dijelu aorte, potencijalno je smrtonosno stanje koje nastaje kao posljedica razdvajanja slojeva aortalnoga zida pri čemu nastaju dva lumena aorte, jedan pravi i jedan lažni. Postoji više klasifikacija disekcije aorte, od kojih je najkorištenija Stanford klasifikacija, koja razlikuje tip A i tip B disekcije aorte. Važnost klasifikacije je u tome što nam ona govori o lokalizaciji disekcije te o mogućnostima liječenja. Stanford tip A disekcija aorte je rijetko, ali životno
ugrožavajuće stanje koje ima smrtnost 1-2% po satu nakon nastanka simptoma u neliječenih pacijenata, stoga je nužna brza i točna dijagnoza kako bi se povećala šansa za preživljenje pacijenta i smanjila učestalost teških komplikacija. Tipični simptomi akutne disekcije uključuju jaku bol u prsima, hipotenziju ili sinkopu i prema tome oponašaju znatno češće dijagnoze poput akutnog infarkta miokarda ili plućne embolije. Raznim dijagnostičkim pretragama moguće je potvrditi ovo stanje, ali se zbog dostupnosti i visoke osjetljivosti i specifičnosti najčešće koristi aortografija višeslojnom kompjutoriziranom tomografijom (engl. Multislice Computed Tomography Aortography, MSCTA), koja je ujedno i zlatni standard u dijagnostici disekcije aorte. Akutna disekcija aorte je hitno kirurško stanje koje mora biti zbrinuto u najkraćem mogućem vremenu, s primarnim ciljem ponovne uspostave protoka krvi kroz pravi lumen u descendentnu aortu. Ovaj rad nastoji objediniti kirurške metode na jednom mjestu te razmotriti njihove prednosti i nedostatke.

Abstract (english)

The aorta is the starting and largest artery of the human body that delivers oxygen-rich blood to all parts of the body. Aortic development begins in the 3rd week of gestation. Aortic wall consist of an inner, middle and outer layer. Aortic dissection is caused by a tear in the inner layer and the penetration of blood between the inner and middle layer, whereby their separation occurs. Type A dissection occurs when a rupture is in the ascending aorta, a potentially fatal condition that occurs as a result of the separation of the layers of the aortic wall resulting in two aortic lumens, one true and one false. There are several classifications of aortic dissection, the one most used is the Stanford classification, which distinguishes type A and type B of aortic dissection. The importance of classification is that it specifies the localization of the dissection and the possibilities of treatment. Stanford type A aortic dissection is a rare but life-threatening condition with a mortality of 1-2% per hour after onset of symptoms in untreated patients, therefore rapid and accurate diagnosis is necessary to increase the patient’s chances of survival and reduce the incidence of severe complications. Typical symptoms of acute type A aortic dissection include severe chest pain, hypotension or syncope and therefore mimic significantly more common diagnoses such as acute myocardial infarction or pulmonary embolism. Various diagnostic tests can confirm this condition, but due to its availability and high sensitivity and specificity, multislice computed tomography aortography (MSCTA) is most often used, which is also the gold standard in the diagnosis of aortic dissection. Acute aortic type A dissection is a surgical emergency which requires treatment as soon as possible, with the primary goal reestablishing proper blood flow through
the aortic lumen into the descending part of the aorta. This review aims to list surgical methods in treatment of Stanford type A aortic dissection and analyze their advantages and disadvantages.

• Keywords: disekcija aorte; Stanford A; kirurgija; klasifikacija; terapija
• Keywords (english): aortic dissection; Stanford A; surgery; classification; therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:843831
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-24 12:16:06