{"id":1179,"date":"2020-04-01T23:39:54","date_gmt":"2020-04-01T21:39:54","guid":{"rendered":"http:\/\/aritmije.kbcsm.hr\/?p=1179"},"modified":"2020-04-09T00:50:46","modified_gmt":"2020-04-08T22:50:46","slug":"zatvaranje-atrijskog-septalnog-defekta-asd","status":"publish","type":"post","link":"http:\/\/aritmije.kbcsm.hr\/zatvaranje-atrijskog-septalnog-defekta-asd\/","title":{"rendered":"Zatvaranje atrijskog septalnog defekta (ASD)"},"content":{"rendered":"<div id='av_section_1'  class='avia-section alternate_color avia-section-huge avia-no-shadow  avia-full-stretch av-section-color-overlay-active avia-bg-style-scroll  avia-builder-el-0  el_before_av_two_third  avia-builder-el-first   container_wrap sidebar_right' style='background-repeat: no-repeat; background-image: url(http:\/\/aritmije.kbcsm.hr\/wp-content\/uploads\/2020\/03\/aritmije-kbcsm-header_5.jpg);background-attachment: scroll; background-position: top center;  '  data-section-bg-repeat='stretch'><div class='av-section-color-overlay-wrap'><div class='av-section-color-overlay' style='opacity: 0.7; background-color: #000000; '><\/div><div class='container' ><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1179'><div class='entry-content-wrapper clearfix'>\n<div class='flex_column_table av-equal-height-column-flextable -flextable' ><div class=\"flex_column av_three_fourth  flex_column_table_cell av-equal-height-column av-align-middle av-zero-column-padding first  avia-builder-el-1  avia-builder-el-no-sibling  \" style='border-radius:0px; '><div  style='padding-bottom:0px; font-size:70px;' class='av-special-heading av-special-heading-h1  blockquote modern-quote  avia-builder-el-2  avia-builder-el-no-sibling  av-inherit-size '><h1 class='av-special-heading-tag '  itemprop=\"headline\"  >Zatvaranje atrijskog septalnog defekta (ASD)<\/h1><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><\/div><div id='after_section_1'  class='main_color av_default_container_wrap container_wrap sidebar_right' style=' '  ><div class='container' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-1179'><div class='entry-content-wrapper clearfix'>\n<div class=\"flex_column av_two_third  flex_column_div av-zero-column-padding first  avia-builder-el-3  el_after_av_section  el_before_av_one_third  avia-builder-el-first  \" style='border-radius:0px; '><section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock  '   itemprop=\"text\" ><p style=\"text-align: justify;\">Atrijski septalni defekt (ASD) je prekid kontinuiteta mi\u0161i\u0107ne pregrade (<em>lat. interatrijski septum<\/em>) koja odjeljuje dvije sr\u010dane pretklijetke (<em>atrija)<\/em>. Postojanje takvog defekta za posljedicu ima komunikaciju izme\u0111u te dvije sr\u010dane \u0161upljine, a ukoliko je defekt dovoljno velik, mo\u017ee do\u0107i i do neprirodnog pretoka krvi (<em>eng. shunt<\/em>) iz lijeve strane srca u desnu, \u0161to dugoro\u010dno mo\u017ee dovesti do niza \u0161tetnih u\u010dinaka kao \u0161to su primjerice sr\u010dano popu\u0161tanje, plu\u0107na hipertenzija, mo\u017edani udar i poreme\u0107aji sr\u010danog ritma.<\/p>\n<p style=\"text-align: justify;\">Radi se o jednoj od naj\u010de\u0161\u0107ih uro\u0111enih sr\u010danih mana. Postoji vi\u0161e oblika defekta, no naj\u010de\u0161\u0107i je tzv. <em>tip <\/em><em>sekundum<\/em>, kod kojeg se opisana komunikacija nalazi na samoj sredini septuma.<\/p>\n<p style=\"text-align: justify;\">Postavljanje dijagnoze je \u010desto ote\u017eano \u010dinjenicom da su bolesnici dugi niz godina potpuno bez simptoma ili imaju minimalne simptome zbog \u010dega se ve\u0107ina poreme\u0107aja detektira tek u odrasloj dobi.<\/p>\n<p style=\"text-align: justify;\">Do unazad nekoliko desetlje\u0107a lije\u010denje je bilo isklju\u010divo kirur\u0161ko, no danas se sve vi\u0161e koristi metoda perkutanog zatvaranja defekta uz pomo\u0107 tzv. okludera koja je od 2018. godine dostupna i u na\u0161oj ustanovi.<\/p>\n<p style=\"text-align: justify;\">\n<p style=\"text-align: justify;\"><strong>Postupak<\/strong><\/p>\n<p style=\"text-align: justify;\">Prije samog postupka svakom bolesniku se iscrpno objasne sve koristi i potencijalni rizici procedure (informirani pristanak bolesnika). Treba istaknuti da je prije i poslije zahvata obvezno uzimanje dvojne antiagregacijske terapije (acetilsalicilna kiselina + klopidogrel) u minimalnom trajanju od 3 mjeseca radi sprje\u010davanja nastanka tromba na samom ure\u0111aju. Tako\u0111er je potrebna profilaksa bakterijskog endokarditisa do 6 mjeseci nakon zahvata.<\/p>\n<p style=\"text-align: justify;\">U sklopu pripreme za zahvat se u\u010dini transezofagijski ultrazvuk kojim se detaljnije odrede karakteristike samog septalnog defekta radi boljeg planiranja intervencije (tip defekta, veli\u010dina, anatomske granice). Istom se metodom isklju\u010di postojanje tromba u aurikuli lijevog atrija.<\/p>\n<p style=\"text-align: justify;\">Sam zahvat se obavlja na na\u010din da se putem preponske vene uvede kateter, uz prethodnu lokalnu anesteziju ubodnog mjesta i intravensku analgosedaciju, koji se dalje putem venskog sustava postavi najprije u desnu sr\u010danu pretkomoru, a potom kroz atrijski septalni defekt u lijevu sr\u010danu pretkomoru. Tako\u0111er se tijekom zahvata postavi i sonda ultrazvu\u010dnog aparata (TEE) u jednjak putem kojom se jasno vizualizira optimalno mjesto postavljanja okludera, dok se druge pak strane mogu rano detektirati ev. komplikacije zahvata (alternativno se mo\u017ee putem druge preponske vene postaviti intrakardijalni ultrazvuk).<\/p>\n<p style=\"text-align: justify;\">Kad je uvodnica pozicionirana na adekvatnom mjestu, okluder se polako otpusti dok ne zatvori defekt septuma. Septalni okluder koji koristimo u na\u0161oj ustanovi sastoji se od dvaju diskova sastavljenih od nitinola koji su me\u0111usobno povezani kratkim centralnim dijelom koji upotpunosti ispunja defekt. Sam sastav okludera pospje\u0161uje proces zatvaranja defekta na na\u010din da u tjednima nakon zahvata poti\u010de prerastanje ure\u0111aja sr\u010danim tkivom \u010dime se defekt definitivno zatvara.<\/p>\n<p style=\"text-align: justify;\">Adekvatan polo\u017eaj okludera potvr\u0111uje se pod kontrolom RTG i transezofagusnog ultrazvuka.<\/p>\n<p style=\"text-align: justify;\">Uspje\u0161nost zahvata je iznimno visoka (98% uspje\u0161no zatvorenih ASD-a 12 mjeseci nakon zahvata) uz nizak rizik od komplikacija (&lt;1%).<\/p>\n<p style=\"text-align: justify;\">Dan nakon zahvata se u\u010dini kontrolni transtorakalni ultrazvuk srca, a isti je potrebno ponoviti u sklopu kontrolnog pra\u0107enja 3 mjeseca od zahvata.<\/p>\n<p style=\"text-align: justify;\">Bolesnik se naj\u010de\u0161\u0107e otpu\u0161ta ku\u0107i dan nakon zahvata ukoliko je postproceduralni tijek protekao uredno.<\/p>\n<\/div><\/section><\/div><div class=\"flex_column av_one_third  flex_column_div av-zero-column-padding  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(atrija).<\/p>\n","protected":false},"author":1,"featured_media":1180,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"spay_email":""},"categories":[39],"tags":[48,79,80],"jetpack_featured_media_url":"http:\/\/aritmije.kbcsm.hr\/wp-content\/uploads\/2020\/04\/Aritmije-kbcsm-ASD1500x720.jpg","_links":{"self":[{"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/posts\/1179"}],"collection":[{"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/comments?post=1179"}],"version-history":[{"count":5,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/posts\/1179\/revisions"}],"predecessor-version":[{"id":1755,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/posts\/1179\/revisions\/1755"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/media\/1180"}],"wp:attachment":[{"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/media?parent=1179"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/categories?post=1179"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/aritmije.kbcsm.hr\/wp-json\/wp\/v2\/tags?post=1179"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}