hrvatski

Atrijski septalni defekt i pulmonalna stenoza u odrasloga bolesnika

Introduction: Atrial septal defects (ASD) account for 10-15% of cases of congenital heart disease. The most common type is ostium secundum. It is often asymptomatic until adulthood. Isolated valvular pulmonic stenosis (PS) comprises approximately 10% of all congenital heart disease. The majority of patients are asymptomatic. Those with severe PS may experience exertional dyspnea and fatigue. In adult patients, combined occurrence of secundum type ASD and pulmonic stenosis is an uncommon condition. Case presentation: 20-years-old male, previously healthy, presented to the hospital emergency department with palpitations and chest pressure. Cardiac examination was notable for a grade 5/6 systolic murmur over Erb's point and over the pulmonary area. Cardiac murmur was first noted at the age of 7. There was no family history of CHD. He is a smoker (20 cigarettes daily). ECG demonstrated sinus rhythm with an incomplete right bundle branch block, vertical axis and possible right ventricular enlargement. Transthoracic echocardiography revealed normal systolic and diastolic left ventricular function with ejection fraction of 65%, moderately enlarged right ventricle, secundum atrial defect with left-to-right shunting and hemodynamically significant pulmonic stenosis. Transesophageal echocardiography revealed a large secundum type defect measuring 23-25 mm in diameter. Inferior venacaval rim was gracile, aortic rim was even smaller. Right heart catheterisation was performed. The left-to-right shunt ratio of pulmonary blood flow to systemic blood flow was assessed to be 2:1. The peak-to-peak pressure gradient across the pulmonary valve was 70-80 mmHg. Coronary angiography findings were normal. Because of unfavorable anatomy for percutaneous ASD closure (inadequate septal tissue rim), we opted to surgically repair both PS and ASD. Valvulotomy was performed and the ASD was closed with a patch. Follow-up echocardiogram showed no shunt and a small mean gradient on pulmonic valve.

Atrijski septalni defekt, pulmonalna stenoza,

nije evidentirano

engleski

Atrial septal defect and pulmonic stenosis in an adult patient

Introduction: Atrial septal defects (ASD) account for 10-15% of cases of congenital heart disease. The most common type is ostium secundum. It is often asymptomatic until adulthood. Isolated valvular pulmonic stenosis (PS) comprises approximately 10% of all congenital heart disease. The majority of patients are asymptomatic. Those with severe PS may experience exertional dyspnea and fatigue. In adult patients, combined occurrence of secundum type ASD and pulmonic stenosis is an uncommon condition. Case presentation: 20-years-old male, previously healthy, presented to the hospital emergency department with palpitations and chest pressure. Cardiac examination was notable for a grade 5/6 systolic murmur over Erb's point and over the pulmonary area. Cardiac murmur was first noted at the age of 7. There was no family history of CHD. He is a smoker (20 cigarettes daily). ECG demonstrated sinus rhythm with an incomplete right bundle branch block, vertical axis and possible right ventricular enlargement. Transthoracic echocardiography revealed normal systolic and diastolic left ventricular function with ejection fraction of 65%, moderately enlarged right ventricle, secundum atrial defect with left-to-right shunting and hemodynamically significant pulmonic stenosis. Transesophageal echocardiography revealed a large secundum type defect measuring 23-25 mm in diameter. Inferior venacaval rim was gracile, aortic rim was even smaller. Right heart catheterisation was performed. The left-to-right shunt ratio of pulmonary blood flow to systemic blood flow was assessed to be 2:1. The peak-to-peak pressure gradient across the pulmonary valve was 70-80 mmHg. Coronary angiography findings were normal. Because of unfavorable anatomy for percutaneous ASD closure (inadequate septal tissue rim), we opted to surgically repair both PS and ASD. Valvulotomy was performed and the ASD was closed with a patch. Follow-up echocardiogram showed no shunt and a small mean gradient on pulmonic valve.

Atrial septal defect, pulmonic stenosis

nije evidentirano