Still is the surgical intervention in patients with septal atrial defects and closing indication „gold standard“?

Introducere: Atrial septal defect (ASD) accounts for 5-10% of congenital heart malformations. ASD is the most common congenital malformation in adults, ex-cluding aortic bicuspidia and mitral valve prolapse. In the case of the Ostium secundum type ASD, percutane-ous closure by umbrella devices gained ground in front of the surgical alternative.

Methods: We will discuss the case of a 18-year-old pa-tient without a cardiovascular history, admitted to our Hospial for routine investigation. He is addressed by a family physician who has found a systolic murmur on physical examination and on a resting ECG a major right bundle branch block, raising the suspicion of a ASD.

Results: At baseline ECG sinus rhythm, ventricular frequency 60bpm, major right bundle branch block. Transthoracic echocardiographic examination which revealed the left ventricle of normal cavity dimensions, normal ejection fraction, dilated atrial cavities, ASD osteum secundum type with left to right shunt, signi-ficantly haemodynamic (Qp>Qs=2.91) confirmed by transesophageal echocardiography (ETE). The size of the defect (23 mm) as well as the rimes of the defect was measured by the ETE, being suitable for percuta-neous closing with an “umbrella” type device. Through the approach of the right femoral vein, after measuring the defect through an occlusive balloon guided by the ETE, the ASD was closed with an Amplatz ASD Occlu-der 26mm device. Evolution was favorable with patient discharge two days later. Although the interatrial septal defect is a congenital defect commonly encountered in women with a ratio of 2:1, we have presented the case of a male patient, asymptomatic, with a significant hemodynamic defect, which was suitable to close the ASD with an „umbrella“ type device.

Conclusions: By this type of intervention, the patient avoided surgery that was until recently the „gold stan-dard“. This case reconfirms the importance of a cor-rect assessment of the young patient in order to detect cardiovascular malformation, for the best therapeutic strategy, the percutaneous closure being the first option in case of suitable ASD ostium secundum type.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)