A CHALLENGING CASE OF PERCUTANEOUS ATRIAL SEPTAL DEFECT CLOSURE

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Abstract ASDs account for 13% of all congenital heart diagnoses at birth but remain asymptomatic until adulthood, when atrial arrhythmias, paradoxical embolization or pulmonary hypertension can develop. A 46–year–old woman, without significant cardiovascular history, was admitted to Cardiology Department for dyspnea at exertion. TTE showed an ASD OS type with large left–to–right shunt (Qp/Qs >1.5) and right heart volume overload, dilated right chambers (RVD0: 50 mm) with good longitudinal ventricular function (TAPSE: 29 mm), moderate tricuspid regurgitation with PAPs estimated of 45 mmHg (TAPSE/PAPs: 0.64). TEE confirmed the presence of a 2 cm circular defect (2.01 cm at 61°, 1.98 cm at 91°, 1.92 cm at 98°), posterior and with a small IVC rim (PS rim: 0.571 cm at 0°, PI rim: 0.670 cm at 59°, IVC rim: 0.466 cm at 112°) but eligible to percutaneous closure. ASD was intra–procedure measured in 3 different TEE planes (0°, 45° and 90°) estimating the device size by adding 30% to the largest measurement (2.53 cm considering an ASD of 1.95 cm). With sizing balloon ASD balloon–stretched diameter resulted 2.25 cm at fluoroscopy and 2.56 cm with stop–flow CDUS technique. The procedure was therefore performed with the implantation of a 2.6 cm device, with good angiographic and echocardiographic final result. At 1–month follow–up TTE, device resulted in proper position without trivial leak, right chambers were less dilated (RVD0: 42 mm) with good longitudinal ventricular function (TAPSE: 32 mm), residual mild tricuspid regurgitation with PAPs estimated of 42 mmHg (TRV: 3.06 m/s, TAPSE/PAPs: 0.76).

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