Dijagnostika i liječenje atrijskog septalnog defekta u odraslih

master's thesis

• Title (english): Diagnosis and treatment of atrial septal defect in adults
• Author: Natalia Ošlaj
• Mentor: Kristina Marić Bešić (mentor)
• Committee member: Maja Strozzi (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Kristina Marić Bešić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Atrijski septalni defekt (ASD) je anomalija s lijevo-desnim pretokom (engl. shunt) krvi kroz otvor u interatrijskoj srčanoj pregradi. Nakon bikuspidnog aortalnog zalistka najučestalija je prirođena srčana greška u odrasloj dobi. Većinu svih otvora čini ASD tipa ostium secundum. Bolesnici s izoliranim defektom često su asimptomatski tijekom djetinjstva i adolescencije. Simptomi poput nepodnošenja napora i dispneje te supraventrikulskih aritmija, javljaju se u većine bolesnika nakon 40. godine života. Dugotrajno volumno opterećenje desne strane srca može dovesti do plućne hipertenzije, pojave bidirekcionog pretoka, a rijetko i do obrata pretoka u desno-lijevi (Eisenmengerov sindrom). Auskultacijom se tipično čuje širok, fiksan rascjep drugog srčanog tona (S2) uz sistolički ejekcijski šum nad pulmonalnim zalistkom. Transtorakalna (TTE) i transezofagealna (TEE) ehokardiografija su slikovne metoda izbora za postavljanje dijagnoze, procjenu hemodinamike i anatomskih karakteristika ASD-a. ASD je potrebno zatvoriti u
simptomatskih te u asimptomatskih bolesnika s volumnim opterećenjem desnog srca bez obzira na dob ukoliko nije prisutna značajna plućna hipertenzija ili Eisenmengerov sindrom. Kardijalna kirurgija je metoda izbora za liječenje primum ASD-a, sinus venosus defekta i defekta koronarnog sinusa dok je transkatetersko zatvaranje metoda izbora za liječenje ASD-a tipa ostium secundum adekvatnih anatomskih karakteristika.

Abstract (english)

Atrial septal defect (ASD) is an open communication between the atria through a defect in the interatrial septum that allows left-to-right shunting of the blood. After a bicuspid aortic valve, atrial septal defect is the most common congenital heart
disease in adulthood. Secundum ASD accounts for the majority of cases. Patients with an isolated defect often remain asymptomatic during childhood and adolescence. Most patients will become symptomatic by the age of 40 years. Exercise intolerance and dyspnea as well as supraventricular arrhythmias are the most common manifestations. Longstanding right-sided volume overload can lead to the development of severe pulmonary hypertension, bidirectional shunting or rarely to right-to-left shunting (Eisenmenger syndrome). The characteristic auscultatory finding is a wide fixed splitting of the second heart sound (S2) and systolic ejection murmur across the pulmonic valve. Transthoracic (TTE) and transoesophageal (TEE) echocardiography are the imaging modalities of choice for the diagnosis of an ASD, assessing its hemodynamic and anatomy variations. ASD should be closed in symptomatic and asymptomatic patients with signs of right heart volume overload, regardless of age but must be avoided in patients with severe pulmonary hypertension or Eisenmenger physiology. Surgery is required for closure of primum ASDs, sinus venos defects, and coronary sinus defects. Transcatheter device closure is the treatment of choice in patients with secundum ASDs with appropriate anatomic characteristics.

• Keywords: prirođene srčane greške; atrijski septalni defekt; ehokardiografija; transkatetersko zatvaranje
• Keywords (english): congenital heart disease; atrial septal defect; echocardiography; transcatheter closure
• Language: croatian
• URN:NBN: urn:nbn:hr:105:203944
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-04-13 08:37:34