The incidence of Atrial Septal Defect (ASD) is approximately 3 per 10,000 live births. Ostium secundum ASD is most common type of ASD accounting for 75% of all ASD cases. Patients with irreversible Pulmonary Arterial Hypertension (PAH) are considered ineligible for shunt closure. It is important to ascertain the cause of PAH particularly to rule out pulmonary cause as in present case. A 56-yearold female patient, known case of Ostium secundum ASD presented with NYHA class IV dyspnea and chest infection. A transthoracic echocardiogram revealed 30 mm ASD with bidirectional shunt, dilated Right Atrium (RA), Right Ventricle (RV), severe Tricuspid Regurgitation (TR) (max PG 85 mmHg) and RV dysfunction. She was intubated and put on mechanical ventilator. CT chest showed right lower lobe bronchiectasis with infective changes. However repeated attempts to wean patient off Bipap support were unsuccessful. Subsequently cardiac catheterization and Balloon Occlusion of ASD revealed Qp/Qs ratio of 8:1 with step up in oxygen saturation of 19%. Mean pulmonary artery pressure was 35 mmHg. Later she underwent successful device closure for ASD with AMPLATZER septal occlude (36 mm) (AGA Medical Corp., Minneapolis, MN, USA). Her physical activity and symptoms were much improved. Follow up transthoracic echocardiography after 5 months revealed normal RV contractility and no PAH. While initially chest infection prevented ASD device closure, underlying bronchiectasis which got worsened by ASD shunt, prevented her from weaning off ventilator. ASD device closure thereby helped to reduce pulmonary blood flow and improvement in lung function enabling her to wean off ventilator support.
Objective: Aorto-iliac occlusive disease (AIOD) is a common atherosclerotic disease causing significant morbidity. Transatlantic intersociety consensus for the management of peripheral arterial disease (TASC II) recommends endovascular therapy (ET) for better management of patients with lesions type A and B. With the advent of endovascular therapy, type C and D lesions management is becoming more feasible with endovascular therapy than open surgery for aorto-iliac occlusive disease. We aimed to evaluate patients with AOID and to describe short-term outcome of endovascular treatment for such lesions. Methods: Patients with aorto-iliac occlusive diseases who underwent endovascular therapy were enrolled in the study. Their demographic data and risk factors were recorded. Patients were followed at 3 and 6 months and their primary patency rate and symptom status were recorded. Results: We enrolled 100 patients with a mean age of 59.77 (8.75) years with the majority of patients being male. The most common presentation was claudication (59%) followed by rest pain (31%) and gangrene (20%). The majority of patients had Transatlantic inter-society consensus (TASC) II type A (44%) and type B (31%) lesions; 15% of patients had types C lesions and the remaining 10% patients had type D lesions. Access site hematoma and contrast-induced nephropathy were present in 7% and 5% of patients respectively. Stent patency rate was 97% and 95% at 3 and 6 months follow up respectively. Conclusion: Endovascular therapy in aorto-iliac occlusive disease is a safe, effective, and low-cost treatment option with a high patency rate and symptomatic improvement in the short-term.
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