Hasan Ali GÜMRÜKÇÜOĞLU, Hakkı ŞİMŞEK, Serkan AKDAĞ, Yılmaz GÜNEŞ, Musa ŞAHİN

Sekundum atriyal septal defekt ve pulmoner hipertansiyon birlikteliğinde gebelik

Atriyal septal defekt (ASD) erişkin yaşta en sık karşılaşılan konjenital kalp defektidır. Klinik olarak genellikle asemptomatik olmasına rağmen, yetişkin hastalarda ritim bozuklukları, nefes darlığı gibi bulgular ile semptomatik hale gelebilir. Konjenital kalp hastalığı olan annelerin gebeliklerinde prognozu ve bebeğin sağlığını, kardiyak defektin yeri, siyanozun olup olmaması, pulmoner vasküler direnç, hemoglobin düzeyi, fonksiyonel kapasite ile cerrahi onarım öyküsü gibi faktörler etkiler. Bu yazımızda; nefes darlığı ve çarpıntı şikayeti ile kardiyoloji polikliniğine başvuran, 29 yaşında, daha önceden konjenital kalp hastalığına sahip olduğu bilinmeyen, 15 haftalık gebeliği olan bir hastayı sunduk. Fizik muayenede; mezokardiyak odakta 2/6, triküspit odakta 3/6 sistolik üfürüm vardı. Transtorasik ekokardiyografide sekundum tip ASD (3 cm), sağ kalp boşluklarında ileri derecede genişleme, orta derecede triküspit yetersizliği olup pulmoner arter sistolik basıncı 60 mmHg olarak ölçüldü. Terminasyonu yapılan hastaya elektif şartlarda cerrahi olarak ASD kapatma işlemi uygulandı.

Pregnancy with both secundum type atrial septal defect and pulmonary hypertension

Atrial septal defect (ASD) is the most common congenital heart disease in adulthood. Although usually clinically asymptomatic in adult patients, it may become symptomatic with rhythm disorders and shortness of breath. Prognosis of pregnancy with congenital heart disease and health of infant were affected by several factors such as location of cardiac defect, presence or absence of cyanosis, degree of pulmonary vascular resistance, hemoglobin level, functional capacity and history of surgical repair. In this case, we presented a 29 years old, 15 weeks pregnant women with previously unknown congenital heart disease who had complaints of shortness of breath and palpitations. In physical examination, we found a grade 2/6 systolic murmur on mezocardiyak focus and 3/6 on tricuspid focus. Transthoracic echocardiography showed secundum type ASD (3 cm), severe right ventricular enlargement, moderate tricuspid regurgitation and increased pulmonary artery systolic pressure (60 mmHg). Pregnancy was terminated and the ASD was occluded surgically in elective conditions.

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