Transcatheter closure of a residual shunt with posteroinferior deficient rim after surgical closure of an ASD: a case report

Xicheng Deng,Yefeng Wang,Wenjuan Chen,Peng Huang,Zhi Chen,Taoyue Yao,Guangxian Yang

doi:10.1186/s12872-020-01624-9

Xicheng Deng, Yefeng Wang + Show 5 more

Open Access

https://doi.org/10.1186/s12872-020-01624-9

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Journal: BMC Cardiovascular Disorders	Publication Date: Jul 22, 2020
Citations: 2	License type: open-access

Affiliation: Hunan Children's Hospital

Abstract

BackgroundThere are few reports in the literature of device closure of residual shunts following initial surgical closure of an atrial septal defect (ASD). This case study reports one such case. We describe here a case of secundum type ASD that was initially closed surgically, followed by device closure of a residual shunt with a posteroinferior deficient rim.Case presentationA 7-month-old boy was admitted to our hospital for elective surgery to surgically correct a secundum type ASD. Unfortunately, a residual shunt 3.5 mm in diameter appeared before discharge and was enlarged at1-year follow-up. The cause of this residual shunt was dehiscence at the posteroinferior aspect, and the posteroinferior rim was 3.7 mm. After careful discussion and preparation, we proceeded with an interventional procedure. A 16 mm ASD occluder (AGA Medical Corp, Plymouth, Minnesota) was deployed successfully with no residual shunt. In some cases of ASD, interventional therapy is not considered due to the size and position of the defect, but we show here, a successful case of interventional therapy for a residual shunt with a deficient rim.ConclusionWe have presented a case in which a postoperative residual shunt with a deficient rim was successfully closed with interventional therapy.

Highlights

BackgroundSecundum type atrial septal defect (ASD) is a common congenital heart defect [1] and interventional device occlusion is the treatment of choice as techniques and devices for transcatheter treatment have been evolved and refined [2,3,4]
There are few reports in the literature of device closure of residual shunts following initial surgical closure of an atrial septal defect (ASD)
We have presented a case in which a postoperative residual shunt with a deficient rim was successfully closed with interventional therapy

Summary

Background

Secundum type atrial septal defect (ASD) is a common congenital heart defect [1] and interventional device occlusion is the treatment of choice as techniques and devices for transcatheter treatment have been evolved and refined [2,3,4]. The defect had been suspected during physical examination for pneumonia and was confirmed with an echocardiography previously at 4-month-old Though he had been generally well and without tachypnea, Deng et al BMC Cardiovascular Disorders (2020) 20:343 tachycardia or cyanosis, etc., the pneumonia could not be ruled out to have had an association with this large ASD. At 1-year follow-up, when the patient was 1 year and 7 months old and weighed 10 kg, an echocardiography suggested the shunt was further enlarged to 8 mm, and the right cardiomegaly had become moderate (Fig. 1d). The 3-month postoperative follow-up showed that the patient was doing well, with the occluder in its proper position and no sign of any residual shunt under echocardiography (Fig. 1f)

Discussion

Conclusions