Case Reports
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Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:28-32
DOI: 10.12945/j.jshd.2018.036.17
Rapid Reduction in Right Atrial Size after Amplatzer Septal Occluder Placement Results in Disc Distortion and Chest Pain Necessitating Device Removal
Leigh Christopher Reardon, MD1,2, Jamil Anis Aboulhosn, MD1
1 Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
2 Departement of Pediatric Cardiology, UCLA Children's Heart Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
Abstract
Patients with a significant shunt from a secundum atrial septal defect (ASD) undergo repair to avoid long-term complications of right ventricular failure, atrial arrhythmias, and pulmonary hypertension. Upon surgical or transcatheter ASD closure, there is an abrupt change in shunt volume, and cardiac remodeling occurs over a period of months to years. Frequently, right-sided dilation does not resolve completely. A 26-year-old man underwent device closure of a large secundum ASD and was observed to have a rapid and profound reduction in right atrial size over an 8-day period. He was asymptomatic for a week following the procedure and then began to experience worsening chest pain. He also experienced various dysrhythmias, including low atrial rhythm with pauses as well as atrial flutter. Echocardiography did not demonstrate pericardial effusion, but electrocardiogram-gated cardiac computed tomography angiography showed the right atrial disc digging into the posterior wall of the right atrium. Despite aggressive medical treatment with non-steroidal anti-inflammatory medication (i.e., opiates and steroids), the patient continued to have daily symptoms. Surgical device removal and ASD repair was carried out 29 days after device placement, which showed no gross evidence of device erosion but that the right atrial disc was compressed into the posterior wall of the right atrium. The patient’s symptoms resolved following recovery.
Cite this article as: Reardon LC, Aboulhosn JA. Rapid Reduction in Right Atrial Size after Amplatzer Septal Occluder Placement Results in Disc Distortion and Chest Pain Necessitating Device Removal. Structural Heart Disease 2018;4(1):28-32. DOI: 10.12945/j.jshd.2018.036.17
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Case Reports
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:28-32
DOI: 10.12945/j.jshd.2018.036.17
Rapid Reduction in Right Atrial Size after Amplatzer Septal Occluder Placement Results in Disc Distortion and Chest Pain Necessitating Device Removal
Leigh Christopher Reardon, MD1,2, Jamil Anis Aboulhosn, MD1
1 Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California, USA
2 Departement of Pediatric Cardiology, UCLA Children's Heart Center, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
Abstract
Patients with a significant shunt from a secundum atrial septal defect (ASD) undergo repair to avoid long-term complications of right ventricular failure, atrial arrhythmias, and pulmonary hypertension. Upon surgical or transcatheter ASD closure, there is an abrupt change in shunt volume, and cardiac remodeling occurs over a period of months to years. Frequently, right-sided dilation does not resolve completely. A 26-year-old man underwent device closure of a large secundum ASD and was observed to have a rapid and profound reduction in right atrial size over an 8-day period. He was asymptomatic for a week following the procedure and then began to experience worsening chest pain. He also experienced various dysrhythmias, including low atrial rhythm with pauses as well as atrial flutter. Echocardiography did not demonstrate pericardial effusion, but electrocardiogram-gated cardiac computed tomography angiography showed the right atrial disc digging into the posterior wall of the right atrium. Despite aggressive medical treatment with non-steroidal anti-inflammatory medication (i.e., opiates and steroids), the patient continued to have daily symptoms. Surgical device removal and ASD repair was carried out 29 days after device placement, which showed no gross evidence of device erosion but that the right atrial disc was compressed into the posterior wall of the right atrium. The patient’s symptoms resolved following recovery.
Supplemental Media
Video 1: Balloon-sizing of the atrial septal defect using a 34-mm sizing balloon. Despite stop-flow, there was no waist on the sizing balloon.
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Video 2: Rotational cineangiogram after device deployment demonstrated excellent positioning of the device.
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Cite this article as: Reardon LC, Aboulhosn JA. Rapid Reduction in Right Atrial Size after Amplatzer Septal Occluder Placement Results in Disc Distortion and Chest Pain Necessitating Device Removal. Structural Heart Disease 2018;4(1):28-32. DOI: 10.12945/j.jshd.2018.036.17
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