Asymptomatic hypoxia in a young pregnant lady — Unusual presentation of atrial septal defect

Krishnamoorthy, Suresh; Butt, Mehmood; Lip, Gregory Y. H.

doi:10.1016/j.ijcard.2008.12.039

Cited by 8 publications

(12 citation statements)

References 7 publications

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“…A small minority of patients diagnosed with an ASD during pregnancy require intervention (2). Indications for intervention include heart failure and pulmonary hypertension with severe hemodynamic compromise, NYHA class > II or recurrent stroke prior to pregnancy.…”

Section: A B C Discussionmentioning

confidence: 99%

Successful percutaneous closure of an extremely large secundum atrial septal defect during pregnancy

Stokes

Nerlekar

et al. 2017

Cardiovasc. Diagn. Ther.

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A 27-year-old Caucasian female at 20 weeks gestation presented with NYHA class II-III dyspnoea and lethargy. Prior to pregnancy, she reported progressive exercise intolerance over the previous year. During adolescence, she often struggled with exercise and physical activities. Her past medical history was only significant for infrequent episodic asthma.Since the onset of pregnancy, the patient experienced worsening dyspnoea on exertion. Screening blood tests including full blood examination and iron studies were unremarkable. Ultrasound of her foetus demonstrated normal foetal development at 20 weeks gestation. A transthoracic echocardiogram (TTE) was requested following the detection of a systolic murmur. This demonstrated a large atrial septal defect (ASD) associated with haemodynamically significant, continuous left-to-right inter-atrial shunting (Qp:Qs shunt ratio: 2.2) and significant right ventricular dilatation. Estimated pulmonary artery systolic pressure was normal.Transoesophageal echocardiogram (TOE) demonstrated an extremely large secundum type ASD (measuring 31, 38 and 30 mm at 0, 50 and 110 degrees respectively). Her right ventricle was moderate-to-severely dilated with low normal right ventricular ejection fraction (Figure 1).The ladies exercise tolerance further worsened at 25 weeks gestation with her walking distance limited to 20 meters walking on flat ground. Her severe symptomatic limitation precluded attempting an exercise test and a cardiac magnetic resonance imaging study was not performed as the ASD and right ventricular size and function were felt to be adequately assessed on TTE and TOE. The patient's case was then extensively discussed at a multi-disciplinary team meeting, involving obstetricians, cardiologists and cardiac surgeons. Conservative management of the ASD was strongly considered as the vast majority of ASDs are well tolerated during pregnancy. However, the decision was made to perform percutaneous closure in this case, given the size of the defect along with her progressive symptoms to NYHA class III. Open surgical management was also considered, however, the need for cardiopulmonary bypass, a sternotomy with the greater associated maternal and foetal risks mandated attempted closure using a percutaneous approach. The patient was also counselled regarding the risks of the procedure, including the requirement of Abstract: Atrial septal defects (ASDs) are one of the most of the most common acyanotic congenital heart lesions. Awareness of potential clinical presentations and complications during pregnancy is essential for those managing these patients. We report successful percutaneous closure of an extremely large secundum ASD, using the largest available percutaneous ASD closure device in a 27-year-old pregnant female. Large ASDs may have their initial clinical presentation and diagnosis during pregnancy. If indicated, percutaneous closure can be performed safely. Only a very small number of cases have previously reported this being performed safely during pregnancy.

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Section: A B C Discussionmentioning

confidence: 99%

Successful percutaneous closure of an extremely large secundum atrial septal defect during pregnancy

Stokes

Nerlekar

et al. 2017

Cardiovasc. Diagn. Ther.

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“…5 Right-to-left shunting can occur across defects in the interatrial septum (ASD or PFO) in the absence of pulmonary hypertension, but are rarely reported. 1,6 This may be related to a flow mediated phenomenon (e.g. platypnea-orthodeoxia syndrome) or in the setting of severe tricuspid regurgitation (i.e.…”

Section: Discussionmentioning

confidence: 99%

Normalisation of hypoxaemia following successful percutaneous closure of a bidirectional shunting secundum atrial septal defect without pulmonary hypertension in a patient with severe non‐ischaemic cardiomyopathy and refractory ventricular tachycardia

Anderson

Wilson

Morton

et al. 2016

Internal Medicine Journal

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Atrial septal defects (ASD) are an uncommon cause of dyspnoea. A high index of suspicion is required, and further investigation should be prompted in patients with unexplained hypoxaemia, particularly those with pulmonary hypertension. Hypoxic ASD without pulmonary hypertension are rare, and only a handful of cases have been published. We present a middle-aged man with progressive dyspnoea with a successfully closed ASD without pulmonary hypertension caused by elevated right ventricular pressures secondary to an idiopathic cardiomyopathy.

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“…In a recently published article entitled "Asymptomatic hypoxia in a young pregnant lady-Unusual presentation of atrial septal defect" by Krishnamoorthy et al [1], there were conflicting data with regard to clinical assessment. The authors stated that the patient had an ejection systolic murmur in the pulmonary area with loud pulmonary component, fixed splitting of S2 and right parasternal heave.…”

Section: Dear Sirmentioning

confidence: 99%

Comments on “Asymptomatic hypoxia in a young pregnant lady—Unusual presentation of atrial septal defect”, Krishnamoorthy S, et al.

Kula

İmren

Olguntürk

2010

International Journal of Cardiology

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Asymptomatic hypoxia in a young pregnant lady — Unusual presentation of atrial septal defect

Cited by 8 publications

References 7 publications

Successful percutaneous closure of an extremely large secundum atrial septal defect during pregnancy

Successful percutaneous closure of an extremely large secundum atrial septal defect during pregnancy

Normalisation of hypoxaemia following successful percutaneous closure of a bidirectional shunting secundum atrial septal defect without pulmonary hypertension in a patient with severe non‐ischaemic cardiomyopathy and refractory ventricular tachycardia

Comments on “Asymptomatic hypoxia in a young pregnant lady—Unusual presentation of atrial septal defect”, Krishnamoorthy S, et al.

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