Cengiz DEMİR, Emine GAZİ, Ahmet BARUTÇU, Ercan AKŞİT, Emir VOLİNA

Situs İnversus Totalis ve Dekstrokardili Hastada Perkütan Yolla Atriyal Septal Defekt Kapatılması

Situs inversus totalis, dekstrokardi ve atriyal septal defekt ile birlikteliği oldukça nadir görülen bir patolojidir. Bu tür pozisyon yerleşim anomalisi olan hastalarda, defektlerin onarımı için farklı yaklaşımların kullanılması gerekir. Bu olgu sunumunda, atriyal septal defekti perkütan olarak kapatılmış bir dekstrokardi hastası sunulmuştur. Kırk yedi yaşında kadın hasta safra kesesi operasyonu hazırlığı sırasında situs inversus totalis ve dekstrokardi tanısı olması nedeniyle kardiyolojik değerlendirme için tarafımıza yönlendirilmiştir. Hastanın kalbi sağ tarafta ve sağ kalp boşluklarında dilatasyon izlenmiş, 15 mm genişliğinde sekundum tipi atriyal septal defekt saptanmıştır. Defekte 20 mm atriyal septal defekt kapatma cihazı (Occlutech, GmbH) yerleştirilmiş ve defekt tamamen kapatılmıştır. Bu olgu sunumuında, dekstrokardi hastalarında müdahaleler planlanırken hangi konulara dikkat edilmesi gerektiği ve teknik farklılıkları tanımlanmıştır.

Percutaneous Closure of the Atrial Septal Defect in a Patient with Dextrocardia and Situs Inversus Totalis

Situs inversus totalis with dextrocardia and atrial septal defect is extremely rare. Different position and inversion types are required different closure techniques. We present a dextrocardia patient whose atrial septal defect was closed percutaneously. A 47-year-old female patient was referred for cardiological evaluation due to the diagnosis of situs inversus totalis and dextrocardia while preparing for gall bladder surgery. The patient’s heart was located on the right side, right heart chambers were dilated and a secundum-type atrial septal defect of 15 mm in width was detected. A 20 mm atrial septal defect closure device (Occlutech, GmbH) was placed and the defect was completely covered. In this case report, we defined technical differences and issues that should be considered when planning interventions in dextrocardia patients.

PDF

___

1. Webb G, Gatzoulis MA. Atrial septal defects in the adult. Circulation 2006;114:1645-53. [Crossref]
2. Podnar T, Martanovic P, Gavora P, Masura J. Morphological variations of secundum type atrial septal defects: feasibility for percutaneous closure using amplatzer septal occluders. Cathet Cardiovasc Intervent 2001;53:386-91. [Crossref]
3. Mozayan C, Levis JT, Facep FAA. Clinical medicine ECG diagnosis: dextrocardia. Perm J 2019;23:18-244. [Crossref]
4. Van de Bruaene A, Stroobants D, Benit E. Percutaneous closure of inter-atrial communications (atrial septal defect and patent foramen ovale): single-centre experience and mid-term follow-up. Acta Cardiol 2015;70:133-40. [Crossref]
5. Gupta R, Soni V, Valse PD, Goyal RB, Gupta AK, Mathur P. Neonatal intestinal obstruction associated with situs inversus totalis: two case reports and a review of the literature. J Med Case Rep 2017;11:264. [Crossref]
6. Van Praagh R, Weinberg PM, Smith SD, Foran RB, Van Praagh S. Malpositions of the heart. In: Adams FA, Emmanouilides GC, Riemenschneider TA (eds). Heart Disease in Infants, Children, and Adolescents. 4th ed. Baltimore: Williams and Wilkins, 1989:554-5. [Crossref]
7. Lev M, Liberthson RR, Eckner FA, Arcilla RA. Pathologic anatomy of dextrocardia and its clinical implications. Circulation 1968;37:975-99. [Crossref]
8. Galal MO, Khan MA, El-Segaier M. Percutaneous closure of atrial septal defect with situs solitus and dextrocardia. Asian Cardiovasc Thorac Ann 2015;23:202-5. [Crossref]
9. Hakim F, Madani A, Samara Y, Ata IA, Hiari A, Goussous Y, et al. Transcatheter closure of secundum atrial septal defect in a patient with dextrocardia using the amplatzer septal occluder. Cathet Cardiovasc Diagn 1998;43:291-4. [Crossref]
10. Onan B, Aydin U, Kahraman Z, Bakir I. Robotic atrial septal defect closure and tricuspid annuloplasty in a case of situs inversus totalis with dextrocardia. J Robot Surg 2017;11:87-90. [Crossref]
11. Raj BS, George OK, Chandy ST. Transcatheter closure of multiple atrial septal defects in situs inversus with dextrocardia. Indian Heart J 2008;60:152-4. [Crossref]
12. Rigatelli G, Cardaioli P, Roncon L. Working in front of the mirror: closure of a defect in the oval fossa of a patient with a mirror-imaged and rightsided heart. Cardiol Young 2007;17:448-9. [Crossref]
13. Yerram S, Aramalla S, Bhyravavajhala S. Unconventional deployment of atrial septal occluder in a patient with atrial septal defect, dextrocardia, and interrupted inferior vena cava. Cardiol Young 2020;30:1206-8. [Crossref]

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi