ASD Device Closure: Case report and discussion

Latha

Echo Technician, Kauvery Hospital, Heart City, Trichy

Introduction

Atrial septal defect (ASD) is a congenital cardiac defect. A hole exists between the upper chambers of the heart in people with ASD. The hole causes more blood to flow through the lungs which leads to unique complications

What impact does it have on the heart?

Typically, the left side of the heart exclusively pumps blood to the body, while the right side solely pumps blood to the lungs. In a child with ASD, blood can flow through the opening from the left upper heart chamber (left atrium) to the right upper chamber (right atrium) and then into the lung arteries.

If the ASD is significant, the increased blood flow into the pulmonary arteries causes the heart and lungs to exert more effort, which can lead to gradual damage of the lung arteries.

If the opening is minor, it might not lead to any symptoms or issues. Numerous healthy adults frequently retain a small remaining gap in the wall separating the atria, which is often referred to as a Patent Foramen Ovale (PFO).

Symptoms

  • Shortness of breath, especially when exercising.
  • Tiredness, especially with activity.
  • Swelling of the legs, feet or belly area.
  • Irregular heartbeats, also called arrhythmias.

What Are the Different Types of ASD?

There are three common types of atrial septal defect (ASD)

  • Ostium Secundum found in the middle of the atrial septum (the most prevalent variety)
  • Ostium Primum found close to the lower part of the atrial septum, could be linked to abnormalities in the mitral and tricuspid valves (the second most prevalent type).
  • Sinus Venosus is positioned near the upper part of the atrial septum and is often linked with an abnormal connection where the right pulmonary vein(s) drains into the right atrium rather than the left atrium (this is the least common variant).

What Are the Long-term Consequences of ASD?

Potential long-term effects of atrial defects may include:

  • Enhanced circulation to the right atrium of the heart (left to right shunting)
  • Volume overload in the chambers on the right side of the heart (left to right shunting)
  • Deterioration of the right ventricle
  • Edema in the neck veins, liver, and limbs
  • Elevated blood flow to the pulmonary system (pulmonary overcirculation)
  • Congestion in the lungs
  • Heightened incidence of respiratory infections
  • Onset of elevated pressures within the pulmonary blood vessels (pulmonary hypertension)
  • Emboli are blood clots that move through the bloodstream. These clots can pass through an atrial septal defect, enter the arterial system, and become trapped in a small artery within the brain, heart, kidneys, arms, or legs. This can lead to serious health issues such as stroke, heart attack, or damage to other organs
  • Irregularities in heart rhythm caused by stretched right atrium/ventricle
  • Sudden unexpected cardiac death, usually due to arrhythmia.

Diagnosis

Echocardiogram. This is the main test used to diagnose an atrial septal defect. Sound waves are used to make pictures of the beating heart. An echocardiogram shows the structure of the heart chambers and valves.

Chest X-ray. A chest X-ray shows the condition of the heart and lungs.

Electrocardiogram (ECG or EKG). This quick and painless test records the electrical activity of the heart. It can show how fast or how slow the heart is beating. An ECG can help find irregular heartbeats, called arrhythmias.

Cardiac magnetic resonance imaging (MRI) scan. This imaging test uses magnetic fields and radio waves to make detailed images of the heart. It might be done if other tests didn’t provide a sure diagnosis.

Electrocardiogram Changes

ECG findings associated with an atrial septal defect may include right atrial enlargement, right axis deviation, PR prolongation (first degree heart block).

High P waves, right bundle branch block, deep S waves in V6, and right axis deviation.

Echocardiographic evaluation

  • Determine the location & size of the heart
  • Establishing the number of defects
  • Measurement of defect margins
  • Guidance of interventional and surgical treatment

Treatment

Treatment for atrial septal defect (ASD) depends on:

  • The size of the hole in the heart.
  • Whether there are other heart problems present at birth.
  • An atrial septal defect may close on its own during childhood. For small holes that don’t close, regular health checkups may be the only care needed.
  • Some atrial septal defects that do not close need a procedure to close the hole. But closure of an ASD isn’t recommended in those who have severe pulmonary hypertension.

ASD Device Closure: Ultra short report

Story of Baby. Hazira – Large ASD – 2 YEARS

Baby of Hazira was diagnosed with an ASD when she was 2 years old. Her parents consulted pediatric cardiologist, and she was on regular check-ups & follow-ups. After carefully examining the entire situation, pediatrician advised ASD device closure surgery for the child.

In children with large atrial septal defect, the right side of the heart can become enlarged. The ASD causes lots of issues/complications to the patients.

Since she has ASD, the required surgery is ASD device closure.

After the successful completion of ASD Device Closure Surgery, the patient and her family were happy with the minimally invasive procedure leaving no marks on her body. She was discharged within a couple of days and is now doing well in her life.

Preoperative ECHO Report

Fig (1): Echocardiography: Sub Coastal view with ASD, from preoperative.

Postoperative ECHO report:

Fig (2): Atrial septal defect occlude – the device closed the defect without residual shunt.

Post repair follow-up

  • Residual/additional ASDs
  • Abnormalities of adjacent valves
  • Monitor LV size and function

Conclusion

ASD is a common congenital defect which is curable. The transcatheter approach had a high success rate, lower rates of adverse events, and shorter hospital stays than surgery, without any mortality.

Baby of Hazira has (Large ASD), which is now closed by an ASD device. The baby is completely all right and safe now.

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