Pregnancy with both secundum type atrial septal defect and pulmonary hypertension

Year 2011, , 452 - 454, 01.12.2011

Serkan Akdağ Hasan Ali Gümrükçüoğlu Hakkı Şimşek Musa Şahin Yılmaz Güneş

https://doi.org/10.5799/ahinjs.01.2011.04.0094

Abstract

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. J Clin Exp Invest 2011; 2 (4): 452-454

Keywords

Atrial septal defect, pregnancy, pulmonary hypertension

Sekundum atriyal septal defekt ve pulmoner hipertansiyon birlikteliğinde gebelik

Abstract

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.

Keywords

Atriyal septal defekt, gebelik, pulmoner hipertansiyon

References

• Miyaji J, Furuse A, Tanaka O, Kubota H, Ono M, Kawauchi M. Surgical repair for atrial septal de- fect in patients over 70 years of age. Jpn Heart J 1997;38(5):677-84.
• Nagao K, Tsuchihashi K, Tanaka S, Iimura O. Stud- ies on atrial arrhythmias in atrial septal defect. The influences of aging on atrial fibrillation. Nippon Ronen Igakkai Zasshi 1995;32(1):27-32.
• Fiore AC, Naunheim KS, Kessler KA, et al. Surgical closure of atrial septal defect in patients older than 50 years of age. Arch Surg 1988;123(8):965-7.
• Kobayashi Y, Nakanishi N, Kosakai Y. Pre-and postoper- ative exercise capacity associated with hemodynamics in adult patient with atrial septal defect:A retrospective study. Eur J Cardiothorac Surg 1997;11(6):1062-6.
• Shibata Y, Abe T, Kuribayashi R, et al. Surgical treat- ment of isolated secundum septal defect in pa- tients more than 50 years old. Ann Thorac Surg 1996;62(4):1096-9.
• Robson SC, Hunter S, Boys RJ et al. Serial study of fac- tors influencing changes in cardiac output during hu- man pregnancy. Am J Physiol 1989; 256(4): 1060-5.
• Thomas TA, Cooper GM. Editorial board of the confi- dential enquiries into maternal deaths in the United Kingdom. Maternal deaths from anaesthesia. An ex- tract from Why mothers die 1997-1999, the Confiden- tial Enquiries into maternal deaths in the United King- dom. Br J Anaesth 2002;89(3):499-508.
• Oakley C and Task Force Members. Expert consensus document on management of cardiovascular diseases during pregnancy. Eur Heart J 2003; 24(8); 761-81.
• Weiss BM, Hess OM, Pulmonary vascular disease and pregnancy: current controversises, management and perspectives. Eur Heart J 2000;21(2): 104-5.
• Oakley C, Pulmonary hypertension in heart disease in pregnancy. London: BMJ Publishing Group, 1997, p. 97-111.
• Madazlı R, Ceydeli N, Tuştaş E, Şen C, Aksu F. Kalp hastalığı ve gebelik olgularının irdelenmesi. Perinato- loji Dergisi 1999; 7(1):31-5.