Postpartum surgical repair of asymptomatic partial atrioventricular septal defect detected during pregnancy
Progress in Pediatric Cardiology, cilt.82, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 82
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.ppedcard.2026.101926
- Dergi Adı: Progress in Pediatric Cardiology
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE
- Anahtar Kelimeler: Adult congenital heart disease, Mitral cleft, Partial atrioventricular septal defect, Pregnancy, Primum atrial septal defect
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Partial atrioventricular septal defect (pAVSD) may remain clinically silent until adulthood. Pregnancy-related hemodynamic and neurohormonal changes can unmask latent defects; however, optimal management strategies and electrophysiological implications in this setting remain incompletely defined. A 28-year-old asymptomatic woman was referred after detection of a systolic murmur and left anterior fascicular block (LAFB) on electrocardiography during late pregnancy. Transthoracic echocardiography (TTE) demonstrated a large primum-type atrial septal defect associated with a mitral valve cleft, mild mitral regurgitation, moderate functional tricuspid regurgitation (TR), right-sided chamber dilatation, and moderate pulmonary hypertension, without a ventricular septal defect. Given maternal hemodynamic stability and to avoid fetal exposure to cardiopulmonary bypass, surgical intervention was electively deferred. One year later, definitive repair was performed with pericardial patch closure of the primum defect and primary mitral cleft repair. Postoperative recovery was uneventful. Follow-up echocardiography showed complete anatomical correction, normalization of right heart dimensions, and spontaneous resolution of TR without direct valve repair. Serial postoperative (Electrocardiographys) ECGs demonstrated resolution of LAFB with restoration of stable sinus rhythm. This case supports the concept of pregnancy as a physiological diagnostic stress test for latent pAVSD and suggests that conduction abnormalities and TR in selected adult patients may be predominantly functional and reversible. Primary mitral cleft repair may further improve left ventricular outflow tract flow symmetry beyond reducing mitral regurgitation.