Proximal Aortic Pathologies
Özet
This comprehensive text outlines the history, anatomy, etiology, diagnosis, classification, and treatment of proximal aortic pathologies. Historically, aortic surgery progressed from early aneurysm ligation to the development of cardiopulmonary bypass and groundbreaking Dacron synthetic grafts. Structurally, the aorta is divided into ascending, arch, descending, and abdominal segments, which heavily dictate clinical approaches. While ascending aneurysms often result from medial degenerative changes, descending aneurysms and acute dissections are strongly linked to predisposing factors like hypertension and hereditary connective tissue disorders, such as Marfan syndrome. Diagnostic options include Computed Tomography (CT), Echocardiography (TTE/TEE), MRI, and aortography. Anatomically, dissections are classified using DeBakey (Types I-III) and Stanford (Types A-B) systems, guiding the choice between medical and surgical management. While uncomplicated Type B dissections undergo medical therapy, Stanford Type A dissections require emergency surgery. Surgical strategies vary based on pathology location, valve condition, and patient characteristics. Notable techniques include the widely preferred Button Bentall procedure, Cabrol technique, Ross pulmonary autograft, valve-sparing remodeling (Yacoub) or reimplantation (David), and reduction aortoplasty. Lastly, endovascular repair offers a viable alternative for high-risk, elderly patients.
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