{"id":2060,"date":"2025-02-16T00:00:00","date_gmt":"2025-02-15T22:00:00","guid":{"rendered":"https:\/\/gynaikologos-komotini.gr\/?p=2060"},"modified":"2026-08-18T12:38:19","modified_gmt":"2026-08-18T09:38:19","slug":"atriyal-septal-defekt","status":"publish","type":"post","link":"https:\/\/gynaikologos-komotini.gr\/tr\/atriyal-septal-defekt\/","title":{"rendered":"Atriyal Septal Defekt"},"content":{"rendered":"\t\t
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Atriyal septal defekt (ASD), en s\u0131k g\u00f6r\u00fclen konjenital kalp defektlerinden<\/strong> biridir ve bu hastal\u0131klar\u0131n yakla\u015f\u0131k %15\u2019ini olu\u015fturur. Tek ba\u015f\u0131na g\u00f6r\u00fclebilece\u011fi gibi di\u011fer anomalilerle birlikte de bulunabilir. K\u0131z\/erkek oran\u0131 yakla\u015f\u0131k 2:1<\/strong> olup k\u0131zlarda daha s\u0131k g\u00f6r\u00fcl\u00fcr.<\/p>

Anatomi<\/h1>

Atriyal septum; septum primum<\/strong>, septum secundum<\/strong> ve sinus venosus<\/strong> ile ili\u015fkili yap\u0131lar\u0131n birle\u015fmesiyle olu\u015fur. Fetal ya\u015famda sa\u011f ve sol atriyumlar foramen ovale<\/strong> arac\u0131l\u0131\u011f\u0131yla birbiriyle ba\u011flant\u0131l\u0131d\u0131r. Do\u011fumdan sonra septum primum ile septum secundumun birbirine yakla\u015fmas\u0131 ve temas etmesi sonucunda foramen ovale fonksiyonel olarak kapan\u0131r.<\/p>

\"\"<\/p>

ASD\u2019ler a\u015fa\u011f\u0131daki tiplere ayr\u0131l\u0131r:<\/p>

\u2022 Ostium secundum defekti<\/strong><\/p>

Defekt atriyal septumun orta b\u00f6l\u00fcm\u00fcnde yer al\u0131r. Boyutu:<\/p>

  • patent foramen ovale (PFO)<\/strong> gibi minimal bir a\u00e7\u0131kl\u0131ktan,<\/li>
  • b\u00fcy\u00fck bir sekundum atriyal septal defekte<\/strong><\/li><\/ul>

    kadar de\u011fi\u015febilir.<\/p>

    \u2022 Ostium primum defekti<\/strong><\/p>

    Defekt atriyal septumun alt b\u00f6l\u00fcm\u00fcnde, atriyoventrik\u00fcler kapaklar\u0131n hemen \u00fczerinde yer al\u0131r. S\u0131kl\u0131kla mitral kapak anomalisi, \u00f6zellikle mitral kapak klefti (cleft)<\/strong> ile birliktedir. Bu anomali endokardiyal yast\u0131k\/atriyoventrik\u00fcler septal defektler<\/strong> spektrumu i\u00e7erisinde de\u011ferlendirilir.<\/p>

    \u2022 Sinus venosus defekti<\/strong><\/p>

    \"\"

    Atriyal septal defekt tipleri: <\/strong>SVC tipi:<\/strong> Sinus venosus tipi atriyal septal defekt
    Ostium primum tipi:<\/strong> Septum primum d\u00fczeyinde atriyal septal defekt
    Ostium secundum tipi:<\/strong> Septum secundum d\u00fczeyinde atriyal septal defekt
    Koroner sin\u00fcs tipi:<\/strong> Koroner sin\u00fcs tipi atriyal septal defekt<\/p><\/div>

    Defekt, vena cava superior veya vena cava inferiorun sa\u011f atriyuma a\u00e7\u0131ld\u0131\u011f\u0131 b\u00f6lgenin yak\u0131n\u0131nda bulunur. Eksantrik yerle\u015fimi nedeniyle tan\u0131s\u0131 s\u0131kl\u0131kla g\u00fc\u00e7t\u00fcr. Genellikle parsiyel anormal pulmoner ven\u00f6z d\u00f6n\u00fc\u015f (PAPVC)<\/strong> ile birliktedir. Bu durumda bir veya daha fazla pulmoner ven sol atriyum yerine sa\u011f tarafl\u0131 dola\u015f\u0131ma drene olur.<\/p>

    \u2022 Koroner sin\u00fcs tipi defekt<\/strong><\/p>

    Bu nadir tip, koroner sin\u00fcs\u00fc sol atriyumdan ay\u0131ran duvar\u0131n k\u0131smen veya tam<\/p>

    amen geli\u015fmemesiyle ili\u015fkilidir (unroofed coronary sinus<\/strong>) ve atriyumlar aras\u0131nda bir ba\u011flant\u0131ya neden olur.<\/p>

    ASD; Holt\u2013Oram sendromu, Noonan sendromu ve Ellis\u2013van Creveld sendromu<\/strong> gibi \u00e7e\u015fitli sendromlar\u0131n yan\u0131 s\u0131ra trizomi 21 ve trizomi 13<\/strong> gibi kromozomal anomalilerle de ili\u015fkili olabilir. Ayr\u0131ca NKX2-5<\/strong> ve GATA4<\/strong> gibi genlerle ili\u015fkili otozomal dominant kal\u0131t\u0131m g\u00f6steren ailesel formlar da tan\u0131mlanm\u0131\u015ft\u0131r.<\/p>

    • \u00a0<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t
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      Patofizyoloji<\/h1>

      Fetal ya\u015famda ASD \u00f6nemli bir hemodinamik etkiye neden olmaz; \u00e7\u00fcnk\u00fc foramen ovale \u00fczerinden ger\u00e7ekle\u015fen sa\u011fdan sola \u015fant<\/strong>, fetal dola\u015f\u0131m\u0131n normal bir par\u00e7as\u0131d\u0131r.<\/p>

      Do\u011fumdan sonra ise ASD, atriyumlar d\u00fczeyinde soldan sa\u011fa \u015fanta<\/strong> neden olur. \u015eant esas olarak diyastol s\u0131ras\u0131nda ger\u00e7ekle\u015fir ve sa\u011f ventrik\u00fclde hacim y\u00fcklenmesine yol a\u00e7ar. Zamanla sa\u011f kalp bo\u015fluklar\u0131nda geni\u015fleme ve pulmoner kan ak\u0131m\u0131nda art\u0131\u015f meydana gelir.<\/p>

      Pulmoner dola\u015f\u0131mdaki artm\u0131\u015f kan ak\u0131m\u0131n\u0131n derecesi Qp:Qs oran\u0131<\/strong> ile ifade edilir ve hem defektin b\u00fcy\u00fckl\u00fc\u011f\u00fcne hem de ventrik\u00fcllerin kompliyans\u0131na ba\u011fl\u0131d\u0131r. Ya\u015f ilerledik\u00e7e sol ventrik\u00fcl kompliyans\u0131n\u0131n azalmas\u0131, defekt \u00fczerinden ge\u00e7en \u015fant\u0131n ve Qp:Qs oran\u0131n\u0131n artmas\u0131na neden olabilir.<\/p>

      Kardiyak Kateterizasyon<\/h4>

      Kardiyak kateterizasyon Qp:Qs oran\u0131n\u0131n<\/strong> belirlenmesini sa\u011flar ve ge\u00e7mi\u015fte defektin kapat\u0131lmas\u0131 karar\u0131nda \u00f6nemli bir referans y\u00f6ntem olarak kullan\u0131lm\u0131\u015ft\u0131r. Bir\u00e7ok \u00e7al\u0131\u015fmada Qp:Qs >1,5:1<\/strong> kapatma a\u00e7\u0131s\u0131ndan \u00f6nemli bir e\u015fik olarak kabul edilmi\u015ftir.<\/p>

      Ayr\u0131ca pulmoner arter bas\u0131nc\u0131n\u0131n ve pulmoner vask\u00fcler direncin do\u011frudan \u00f6l\u00e7\u00fclmesinde referans y\u00f6ntemdir.<\/p>

      G\u00fcn\u00fcm\u00fczde hemodinamik y\u00fck \u00e7o\u011funlukla non-invaziv y\u00f6ntemlerle de\u011ferlendirilebilmekte; kardiyak kateterizasyon ise uygun olgularda esas olarak transkateter cihaz ile defektin kapat\u0131lmas\u0131<\/strong> amac\u0131yla kullan\u0131lmaktad\u0131r.<\/p>

      Klinik Seyir ve Tedavi<\/h1>

      Hastalar genellikle asemptomatik kal\u0131r. Kalp yetmezli\u011fi bulgular\u0131 baz\u0131 hastalarda ya\u015fam\u0131n ikinci veya \u00fc\u00e7\u00fcnc\u00fc dekad\u0131nda ortaya \u00e7\u0131kabilir.<\/p>

      Pulmoner hipertansiyon ve Eisenmenger sendromu<\/strong> geli\u015fimi en ciddi komplikasyonlardan biridir ve \u00f6nemli morbidite ve mortalite ile ili\u015fkilidir. Pulmoner hipertansiyonun hastalar\u0131n yakla\u015f\u0131k %10\u2019unda geli\u015febildi\u011fi tahmin edilmektedir ve \u00e7ok nadir durumlarda, yakla\u015f\u0131k 10 ya\u015f gibi olduk\u00e7a erken ya\u015flarda da bildirilmi\u015ftir.<\/p>

      Hemodinamik y\u00fck\u00fcn tek ba\u015f\u0131na pulmoner hipertansiyon geli\u015fimini a\u00e7\u0131klamayabilece\u011fi ve baz\u0131 bireylerde ek bir yatk\u0131nl\u0131\u011f\u0131n bulunabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmektedir.<\/p>

      D\u00fczeltmenin pulmoner hipertansiyon geli\u015fmeden \u00f6nce yap\u0131lmas\u0131 gerekti\u011finden, kapatma endikasyonu bulunan olgularda i\u015flemin \u00e7ocukluk d\u00f6neminde ger\u00e7ekle\u015ftirilmesi \u00f6nerilir. Yenido\u011fanda ASD tan\u0131s\u0131 konuldu\u011funda, \u00f6zellikle k\u00fc\u00e7\u00fck sekundum defektlerde spontan k\u00fc\u00e7\u00fclme veya kapanma g\u00f6r\u00fclebilece\u011finden asemptomatik hastalar genellikle takip edilir.<\/p>

      Defekt cerrahi olarak<\/strong> veya anatomik olarak uygun sekundum ASD\u2019lerde transkateter cihaz kapat\u0131lmas\u0131<\/strong> y\u00f6ntemiyle kapat\u0131labilir.<\/p>

      Ya\u015f ilerledik\u00e7e sin\u00fcs d\u00fc\u011f\u00fcm\u00fc disfonksiyonu ve atriyal aritmiler geli\u015febilir. Bu komplikasyonlar\u0131n ortaya \u00e7\u0131kmas\u0131 yaln\u0131zca uygulanan tedavi y\u00f6nteminden de\u011fil, \u00f6zellikle d\u00fczeltmenin zamanlamas\u0131ndan ve i\u015flem \u00f6ncesinde sa\u011f kalp bo\u015fluklar\u0131nda geli\u015fmi\u015f olan geni\u015flemenin derecesinden etkilenmektedir.<\/p>

      Atriyal d\u00fczeyde bir ba\u011flant\u0131 bulundu\u011funda paradoksal emboli<\/strong> geli\u015febilir. Ancak yaln\u0131zca ASD\u2019nin varl\u0131\u011f\u0131, paradoksal embolinin \u00f6nlenmesi amac\u0131yla defektin kapat\u0131lmas\u0131 i\u00e7in tek ba\u015f\u0131na yeterli bir endikasyon de\u011fildir. Bu nedenle kapatma, uluslararas\u0131 k\u0131lavuzlara g\u00f6re se\u00e7ilmi\u015f olgularda uygulan\u0131r.<\/p>

      \u0130zole ASD\u2019de infektif endokardit<\/strong> son derece nadirdir ve rutin endokardit profilaksisi \u00f6nerilmez.<\/p>

      Cerrahi tedavi gerekti\u011finde genellikle \u00e7ocukluk d\u00f6neminde uygulan\u0131r.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

      Atriyal septal defekt (ASD), en s\u0131k g\u00f6r\u00fclen konjenital kalp defektlerinden biridir ve bu hastal\u0131klar\u0131n yakla\u015f\u0131k %15\u2019ini olu\u015fturur. Tek ba\u015f\u0131na g\u00f6r\u00fclebilece\u011fi gibi di\u011fer anomalilerle birlikte de bulunabilir. [\u2026]<\/span><\/p>\n","protected":false},"author":3,"featured_media":-1,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[123,89,88],"tags":[],"class_list":["post-2060","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-fetusun-anatomik-anomalileri-organ-sistemlerine-gore-icerik","category-kardiyak-defektler","category-konjenital-defektler"],"yoast_head":"\nAtriyal Septal Defekt - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD<\/title>\n<meta name=\"description\" content=\"Atriyal septal defekt (ASD), en s\u0131k g\u00f6r\u00fclen konjenital kalp defektlerinden biridir ve bu hastal\u0131klar\u0131n yakla\u015f\u0131k \u2019ini olu\u015fturur. Tek ba\u015f\u0131na g\u00f6r\u00fclebilece\u011fi gibi di\u011fer anomalilerle birlikte de bulunabilir. K\u0131z\/erkek oran\u0131 yakla\u015f\u0131k 2:1 olup k\u0131zlarda daha s\u0131k g\u00f6r\u00fcl\u00fcr.\" \/>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Atriyal Septal Defekt - \u0391\u03bb\u03ad\u03be\u03b1\u03bd\u03b4\u03c1\u03bf\u03c2 \u039c\u03ac\u03b9\u03bd\u03b1\u03c2 MD, PhD\" \/>\n<meta property=\"og:description\" content=\"Atriyal septal defekt (ASD), en s\u0131k g\u00f6r\u00fclen konjenital kalp defektlerinden biridir ve bu hastal\u0131klar\u0131n yakla\u015f\u0131k \u2019ini olu\u015fturur. Tek ba\u015f\u0131na g\u00f6r\u00fclebilece\u011fi gibi di\u011fer anomalilerle birlikte de bulunabilir. 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