Işik Ömer, Kizilay Kardelen, Dik Mehmet, Ülvan Nedret
Cardiology, Firat University Hospital, Elazig, TUR.
Medical School, Faculty of Medicine, Istinye University, Istanbul, TUR.
Cureus. 2025 Apr 11;17(4):e82066. doi: 10.7759/cureus.82066. eCollection 2025 Apr.
Congenital heart disease (CHD) is one of the most common congenital anomalies influenced by both genetic and environmental factors. Atrial septal defect (ASD) and ventricular septal defect (VSD) are among the most common types of CHD. ASD is more common in females and often remains asymptomatic during childhood, leading to delayed diagnosis. Both surgical and percutaneous closure techniques are used, with evidence supporting early intervention for improved outcomes. This study presents the case of a female patient with CHD, including ASD, VSD, and a bifid left ventricular apex, who was treated with both surgical and percutaneous approaches. The patient underwent open heart surgery for ASD closure at the age of 17 years. Eight years later, residual ASD and VSD were identified, and percutaneous transcatheter closure was performed using closure devices. Post-procedural imaging confirmed successful defect closure, a significant reduction in left-to-right shunting, and a decrease in right ventricular pressure. However, residual mitral valve prolapse and moderate mitral regurgitation persisted, requiring ongoing monitoring. The presence of a bifid apex in this patient adds a unique anatomic consideration to managing CHD. While typically considered a benign variant, its association with other structural abnormalities requires careful evaluation. Future management strategies should include detailed imaging studies, such as cardiac MRI, to assess long-term ventricular function and detect potential complications. This case highlights the importance of a comprehensive, multimodal management strategy that includes surgical and transcatheter techniques for complex coronary artery disease cases. Regular follow-up with echocardiography and cardiac MRI is essential to monitor residual defects, assess ventricular function, and ensure long-term treatment success. Early detection and timely intervention are critical to optimizing patient outcomes, preventing complications, and improving quality of life.
先天性心脏病（CHD）是最常见的先天性畸形之一，受遗传和环境因素影响。房间隔缺损（ASD）和室间隔缺损（VSD）是CHD最常见的类型。ASD在女性中更常见，在儿童期通常无症状，导致诊断延迟。手术和经皮封堵技术均有应用，有证据支持早期干预以改善预后。本研究介绍了一名患有CHD的女性患者的病例，包括ASD、VSD和左心室双尖，该患者接受了手术和经皮治疗。患者17岁时接受了开胸手术闭合ASD。八年后，发现残留的ASD和VSD，并使用封堵装置进行了经皮导管封堵。术后影像学检查证实缺损成功闭合，左向右分流显著减少，右心室压力降低。然而，残留的二尖瓣脱垂和中度二尖瓣反流持续存在，需要持续监测。该患者存在双尖增加了CHD管理中独特的解剖学考虑因素。虽然通常被认为是一种良性变异，但其与其他结构异常的关联需要仔细评估。未来的管理策略应包括详细的影像学检查，如心脏MRI，以评估长期心室功能并检测潜在并发症。该病例强调了综合多模式管理策略的重要性，该策略包括针对复杂冠状动脉疾病病例的手术和经导管技术。定期进行超声心动图和心脏MRI随访对于监测残留缺损、评估心室功能和确保长期治疗成功至关重要。早期发现和及时干预对于优化患者预后、预防并发症和提高生活质量至关重要。
