Bifasiküler Blok Saptanması İle Tanı Alan Asemptomatik Bir Atriyoventriküler Septal Defekt Olgusu

Abstract

Ventrikül içinde uyarı iletimindeki gecikmenin sağ daldan, sol ana dal ile sol ön ve arka fasiküllerin ikisine yerleştiği durumlara bifasiküler blok adı verilmektedir. Konjenital veya edinsel kalp hastalıklarına bağlı olarak ortaya çıkabilmektedir. Dört yaşındaki kız hasta, genel anestezi altında diş çekimine hazırlık amacıyla çekilen elektrokardiyografisinde (EKG) superior QRS aksı ile birlikte sağ dal bloğu ve sol anterior hemiblok saptanması üzerine çekilen ekokardiyografisinde interventriküler geçişin ortak AV kapağın bridging lifletleri tarafından engellendiği komplet atriyoventriküler septal defekt saptandı. Yapılan anjiyografisinde primum ASD’den minimal geçiş izlenen hasta hemodinamik stabil olması nedeniyle klinik izlem kararı alındı. Sonuç olarak, dikkatli EKG incelemesi ile asemptomatik seyreden primum ASD’li hastaların pulmoner vasküler hastalık gelişmeden tanı alması sağlanabilir.

Keywords

• Atriyoventriküler septal defekt, Elektrokardiyografi, Fasiküler blok

by Determination of the Bifascicular Block An Asymptomatic Patient with Atrioventricular Septal Defect Diagnosed

Abstract

Bifascicular block is defined as left bundle branch block or right bundle branch block associated either with a left anterior or left posterior fascicular block. It can be due to congenital or acquired heart disease. Electrocardiography for preparation before dental extraction therapy under general anesthesia in a 4-year-old girl showed superior QRS axis, right bundle branch block and left anterior hemiblock. Echocardiographic examination revealed complete atrioventricular septal defect that prevented interventricular transition by bridging leaflets. Angiography showed minimal left to right shunt via the primum ASD. Clinical follow-up was decided on as the patient was hemodynamically stable. Primum atrial septal defect can be diagnosed before the development of pulmonary vascular disease by careful assessment of the ECG in asymptomatic patients

Keywords

• Atrioventricular septal defect, Electrocardiography, Fascicular block

References

1. Park MK, Guntheroth WG. How to Read Pediatric ECGs. 4 th ed. Philadelphia: Mosby, 2006: 94
2. Park MK. Pediatric Cardiology for Practitioners. 5 th ed. Philadelphia: Mosby, 2008:181-7
3. Singh RR, Warren PS, Reece TB, Ellman P, Peeler BB, Kron Il. Early repair of complete atrioventricular septal defect is safe and effective. Ann Thorac Surg 2006; 82:1598-601.
4. Ho SY, Russell G, Gerlis lM. Atrioventricular septal defect with intact septal structures in a 74-year-old. Int J Cardiol 1990; 26: 371–3.
5. Silverman nH, Ho SY, Anderson RH, Smith A, Wilkinson Jl. Atrioventricular septal defect with intact atrial and ventricular septal structures. Int J Cardiol 1984; 5: 567–73.
6. Piccoli GP, Gerlis lM, Wilkinson Jl, lozsadi K, Macartney FJ, Anderson RH. Morphology and classification of atrioventricular defects. Br Heart J 1979; 42: 621–32.
7. Thiene G, Wenink AC, Frescura C, Wilkinson Jl, Gallucci V, Ho SY, et al. Surgical anatomy and pathology of the conduction tissues in atrioventricular defects. J Thorac Cardiovasc Surg 1981; 82: 928–37.
8. Fournier A, Young M, Garcia Ol, Tamer DF, Wolff GS. Electrophysiologic cardiac function before and after surgery in children with atrioventricular canal. Am J Cardiol 1986; 57: 1137–41.