Atriyal septal defekt

Özet

Atriyal septal defekt, atriyumlar arasında doğuştan bulunan bir açıklık veya venöz giriş düzeyindeki septal gelişim anomalisi olup; uzun süreli soldan sağa şant sağ kalp hacim yüküne yol açabilir. EKG eşlemeli kontrastlı BT, özellikle sinus venosus defektinde açıklığın yerini ve eşlik eden parsiyel anormal pulmoner venöz dönüşleri anatomik olarak haritalandırır. Ekokardiyografi kardiyak CHD'de birinci basamak görüntülemedir; hemodinamik değerlendirmede CMR ve gerekirse BT tamamlayıcı bilgi sağlar. Gözden kaçan anormal pulmoner ven dönüşü, sağ kalp genişlemesinin nedeninin ve cerrahi anatominin eksik tanımlanmasına neden olabilir.

Faz ve pencere

BTA tanısal

EKG eşlemeli kontrastlı kardiyak BT’de fossa ovalis, atriyoventriküler bileşke ve vena kava-sağ atriyum birleşimindeki septal devamlılık değerlendirilir; sinus venosus tipinde üst veya alt kavoatriyal bileşkede açıklık ve pulmoner venlerin SVC, IVC ya da sağ atriyuma anormal drenajı izlenebilir. Sağ atriyum ve sağ ventrikül genişlemesi, sol-sağ şanta bağlı hacim yükünün varlığını gösterir.

Önerilen pencereler: Mediasten (G 350 / M 50), Yumuşak doku (G 400 / M 40), Anjiyo (G 600 / M 150).

BT bulguları

• Ostium secundum defektinde fossa ovalis düzeyinde interatriyal septumun orta bölümünde açıklık veya doku eksikliği.
• Ostium primum defektinde atriyoventriküler kapaklara komşu alt septumda açıklık; eşlik eden atriyoventriküler septal bileşke anomalisi.
• Sinus venosus defektinde SVC-sağ atriyum veya daha seyrek IVC-sağ atriyum birleşiminde septumun üst ya da alt kenarında açıklık.
• Sağ üst pulmoner venin veya diğer sağ pulmoner venlerin sol atriyum yerine SVC ya da sağ atriyuma bağlandığı parsiyel anormal pulmoner venöz dönüş.
• Uzun süreli hacim yüküyle uyumlu sağ atriyum ve sağ ventrikül genişlemesi; interventriküler septumda düzleşme görülebilmesi.
• Koroner sinüs çatısındaki defektin sol atriyumla koroner sinüs arasında bağlantı oluşturması.
• İnteratriyal kontrast opasifikasyon farkı tek başına şant akımını göstermez; kontrastlı BT şant akımını değerlendiremez.

Ölçütler ve sınıflamalar

Anatomik ASD tipleri

Ostium secundum: fossa ovalis düzeyinde orta septum. Ostium primum: atriyoventriküler kapaklara komşu alt septum. Sinus venosus: SVC-RA veya IVC-RA bileşkesinde, septumun üst/alt kenarında. Koroner sinüs tipi: koroner sinüs çatısının kısmen veya tamamen yokluğu ile sol atriyum-koroner sinüs iletişimi.

Normalde

Normal interatriyal septum fossa ovalisi çevresinde kesintisiz ince doku olarak sağ ve sol atriyumu ayırır; pulmoner venler sol atriyuma açılır ve sağ kalp boşlukları sol tarafa göre belirgin hacim genişlemesi göstermez. Septumu fossa ovalis, AV kapak düzlemi ve vena kava birleşimleri boyunca izleyin; pulmoner venlerin her birinin sol atriyumla bağlantısını aynı kontrastlı hacimde doğrulayın.

Ayırıcı tanı

Patent foramen ovale

üst üste binen septum primum ve secundum arasında oblik bir tünel bulunur; gerçek bir septal açıklık (doku kaybı) değil, örtüşen yaprakların oluşturduğu geçicidir.

Sinus venosus tipi parsiyel anormal pulmoner venöz bağlantı

SVC veya IVC’ye açılan pulmoner venler, septal defekt gözden kaçsa bile birlikte bulunması sinus venosus tipini düşündürür.

Sağ ventrikül hacim yükünün diğer nedenleri

pulmoner kapak yetersizliği veya başka soldan sağa şantlar sağ boşlukları genişletebilir; interatriyal açıklık ve venöz bağlantılar ayrıca aranır.

Atriyal septal anevrizma, interatriyal septum anomalileri arasında yer alır.

Koroner sinüs çatısı defekti

klasik fossa ovalis açıklığı yerine sol atriyum ile genişlemiş koroner sinüs arasında bağlantı izlenir.

Tuzaklar

• İnteratriyal septum anatomisini BT verilerinden dikkatle yeniden yapılandırılmış çok düzlemli görüntülerde değerlendirin.
• Kontrastlı BT septal şant akımını değerlendiremez; opasifikasyon farkı tek başına şantın varlığını göstermez.
• Sinus venosus defekti çoğu zaman fossa ovalis içinde değil kavoatriyal bileşkededir; pulmoner venlerin tamamını SVC ve IVC boyunca ayrı ayrı izleyin.
• Sağ kalp genişlemesi ASD’ye özgü değildir; doğrudan septal bulgu ve pulmoner ven bağlantıları gösterilmeden yalnızca hacim artışı bulgusundan defekt tipi çıkarılmamalıdır.

Kendini dene

1. Sağ ventrikül geniş; sağ üst pulmoner ven SVC’ye açılıyor ve açıklık üst kavoatriyal sınırda. En olası defekt tipi nedir?

   • Sinus venosus
   • Ostium secundum
   • Ostium primum
   • Patent foramen ovale
   Cevabı göster

   Sinus venosus. Üst kavoatriyal açıklıkla SVC’ye anormal pulmoner venöz dönüş sinus venosus tipini destekler. Secundum defekt fossa ovalis merkezindedir; primum alt AV bileşkeye komşudur; patent foramen ovale ise örtüşen septal yaprakların tünelidir.

2. Fossa ovalis düzeyinde örtüşen ince septal yapraklar arasında oblik tünel izleniyor; doku kaybı yok. En olası yapı nedir?

   • Patent foramen ovale
   • Ostium secundum
   • Sinus venosus
   • Ostium primum
   Cevabı göster

   Patent foramen ovale. Örtüşen septum primum ve secundum arasındaki oblik tünel patent foramen ovale görünümüdür. Secundum ASD gerçek orta septal doku açıklığıdır; sinus venosus kavoatriyal bileşkededir; primum defekt alt septumda AV kapaklara komşudur.

İlgili konular

• Parsiyel anormal pulmoner venöz dönüş

Kaynaklar

Bu sayfadaki 42 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 11 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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