Staged approach for the management of atrial septal defect in the presence of a small left ventricle and suprasystemic pulmonary pressure

Abstract

R Tal, Y Schwartz, A Lorber. Staged approach for the management of atrial septal defect in the presence of a small left ventricle and suprasystemic pulmonary pressure. Curr Res Cardiol 2014;1(2): 114-116. A 29-year-old woman presented with a symptomatic large atrial septal defect, a small left ventricle with a modest left atrium, mild to moderate nonrheumatic mitral valve incompetence, an apex-forming very large right ventricle and suprasystemic pulmonary artery pressure. Following one year of preprocedural drug treatment to lower pulmonary hypertension, she underwent percutaneous closure of the atrial septal defect with a customized fenestrated device that enabled gradual adaptation to the occlusion of the interatrial communication. This special case demonstrates the benefits of using a fenestrated occluder device in patients with pulmonary hypertension and components of left ventricular diastolic dysfunction, which is considered to be high risk and not amenable to therapeutic intervention.

The left ventricle in atrial septal defect: Looking through 3D glasses

“…Beyond the age of 5 years, or with weight > 15 kg, delayed excursion of lateral wall was increasingly observed (42% as compared to 20% in <15 kg). Although aging may play a role in left ventricular dysfunction due to hypertension, ischemia, atherosclerosis, or other comorbidities, the predominance of lateral LV wall dyssynchrony was seen as early as 6 years, in our study. A probable explanation, in keeping with the Frank–Starling mechanism, is that decreased LV filling leads to decreased muscle fiber tension and decreased velocity of fiber shortening, translating into a delay in segmental contraction.…”

“…Atrial septal defect (ASD) is one of the commonest congenital heart defects . As patients are mostly asymptomatic, there is often a delay in closure of the defects . Left ventricular (LV) dysfunction has been observed in adults after closure of atrial septal defects .…”

Challenges in Atrial Septal Defect Occlusion

“…Other causes of atrial right-to-left shunt, including pulmonary disease, pulmonary vascular disease, RV hypertrophy, RV loon occlusion test with RA pressure monitoring is a prudent approach. A fenestrated occluder may be considered as a temporary vent mechanism [33].…”