funda yılmaz pratik cvs 2014 2015
TRANSCRIPT
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KARDİYOVASKÜLER SİSTEM PRATİK
Prof. Dr. Funda YILMAZ BARBET Ege Üniversitesi Tıp Fakültesi
Patoloji Anabilim Dalı Ekim 2014
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KONJENİTAL KALP HASTALIKLARI
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Ostium sekundum tipi Atrial Septal Defekt
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Primum
Secundum
Atrial Septal Defekt
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Müsküler Ventriküler Septal Defekt (VSD)
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MEMBRANÖZ Ventriküler Septal Defekt (VSD)
En sık VSD tipi
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FALLOT TETRALOJİSİ
Sağ ventrikül çıkış bozukluğu (subpulmoner stenoz)
Membranöz VDS
Septal defekt üzerinden geçen sağa kaymış aort
Sağ ventrikül hipertrofisi
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FALLOT TETRALOJİSİ
VSD üzerinde Aort
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FALLOT TETRALOJİSİ
VSD üzerinde Aort
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FALLOT TETRALOJİSİ Pulmoner kapakta tam atrezi varsa akciğerlere kan ya Patent Duktus Arteriozus ya da akciğer arterleri ve aort arasındaki kollaterallerle gider
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FALLOT TETRALOJİSİ Pulmoner kapakta tam atrezi varsa akciğerlere kan ya Patent Duktus Arteriozus ya da akciğer arterleri ve aort arasındaki kollaterallerle gider
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Aort
Pulmoner arter
Aort kökü önde, normalde pulmoner arterin arkasındadır
BÜYÜK DAMARLARIN TRANSPOZİSYONU
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BÜYÜK DAMARLARIN TRANSPOZİSYONU
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Aort koarktasyonu
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Aort koarktasyonu türbülan akıma yol açarak ateroskleroza da zemin hazırlar
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Sub-aortik
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Hipoplastik sol kalp sendromu
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AORT ANEVRİZMASI AORT DİSEKSİYONU
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• ANEVRİZMA: Bir damar duvarı veya kalbin duvarında lokalize, anormal dilatasyon
Yalancı anevrizma: Damar duvarı bütünlüğü bozulmuş,sızan kanın oluşturduğu hematom çevre dokularca sınırlanmış
Gerçek anevrizma:
Damar duvarı bütünlüğü tam
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Gerçek anevrizmalar
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Yalancı anevrizmalar (Psödoanevrizmalar): İntravasküler bölge ile iştirakli ekstravasküler
hematom kitlesi (pulsatil hematom)
– Perikardiyal adezyon ile kapatılan MI sonrası miyokard rüptürü
– Normal arter ile greft damar arasındaki sızıntı
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AORT ANEVRİZMALARI
Abdominal aort: Aterosklerotik aort anevrizması
Torakal aort: Sifilitik aort anevrizması
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Anevrizmanın duvarı ince ve lümen organize trombüs ile dolu
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AORT ANEVRİZMASI VE ORGANİZE TROMBÜS
Organize trombüs
Anevrizma
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Aterosklerotik abdominal aort anevrizmasi
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SİFİLİTİK AORT ANEVRİZMASI
Torakal aort
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Sifilitik anevrizma aortun inen parçası
Fibröz nedbelerin kontraksiyonu intimada dallanan ağaç görünümüne neden olur
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SİFİLİTİK ANEVRİZMA
• Aort elastisitesini kaybeder ve genişler
• Aort kapağı halkasında dilatasyon aort yetmezliği
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SİFİLİTİK ANEVRİZMA
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AORT DİSEKSİYONU • Kanın aortun media tabakasının katmaları arasına
girerek bir kanla dolu kanal oluşturacak şekilde ilerlemesi
• Aortta dilatasyon genellikle olmaz (dissekan anevrizma terimi doğru değil)
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Stanford Sınıflaması
Tip A: Proksimal, inen aortu içerir
Tip B: Subklavian arterin distalinden başlar, çıkan aortu içermez
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Ateroskleroz varsa diseksiyonu durdurur
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Medial dejenerasyon: Mediada elastik dokuda parçalanma ve elastik ve fibro-müsküler elemanların ayırışmasına neden olan elastik doku kaybı
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İnen Aort disseksiyon
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Tip A: Proksimal, inen aortu içerir
Tip B: Subklavian arterin distalinden başlar, çıkan aortu içermez
AORT DİSEKSİYONU
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KAPAK HASTALIKLARI
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Romatizmal kalp hastalığında bağlı: Kapakçıklarda diffüz kalınlaşma ve distorsiyon, komissürlerde füzyon (balık ağzı, düğme iliği deformitesi)
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Romatizmal kalp hastalığına bağlı mitral stenoz: Kapakçıklarda diffüz kalınlaşma ve distorsiyon, komissürlerde füzyon (balık ağzı, düğme iliği deformitesi)
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Aort kapağında kalınlaşma ve fibrozis
Mitral kapakta kalınlaşma ve fibrozis
Kalınlaşmış ve kısalmış korda tendinealar
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Senil kalsifik aort stenozu
Romatizmal aort stenozundan farklı olarak komissür füzyonu yoktur
Valsalva sinüslerinde kalsifiye kitleler
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KONJENİTAL BİKÜSPİD AORT
KAPAĞI STENOZU
İki kapakçık var. Okun olduğu yer ayrılma kusurunun olduğu bölge
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MİTRAL ANNULUS KALSİFİKASYONU
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Mitral kapak prolapsusu
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Mitral kapak prolapsusu
Kapakçığın sol atriuma değdiği yerde trombotik plaklar
Yaprakçıkta balonlaşmalar ve kenarda mitral annulus kalsifikasyonu
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PERİKARDİT
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Fibrinöz perikardit
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Fibrinöz perikardit
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Pnömoni odağından yayılan akut süpüratif perikardit
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Pürülan perikardit
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Fibrinöz perikardit
Yapışıklıklar
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Hemorajik perikardit:
Fibrin + hemoraji
Sadece hemoraji:
Hemoperikardiyum
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Konstriktif perikardit
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Konstriktif perikardit
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