Page 17 - Journal of Structural Heart Disease Volume 3, Issue 2

Case Report
Journal of Structural Heart Disease, April 2017, Volume 3, Issue 2:43-48
DOI: http://dx.doi.org/10.12945/j.jshd.2017.009.16
Received: July 31, 2016 Accepted: Septemper 25, 2016 Published online: April 2017
Successful Percutaneous Device Closure
for Giant Atrial Septal Defect with Massive
Pericardial E usion and Pulmonary
Hypertension in an Elderly Patient
Noriko Kikuchi, MD1, Tomohiro Sakamoto, MD1*, Takashi Saito, MD1, Kazuhiro Nishigami, MD1, Teiji Akagi, MD2, Takashi Honda, MD1, Koichi Nakao, MD1
1 Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan 2 Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan
Abstract
pre- and postoperative medical therapy, device closure with an ASO, and pericardiostomy were e ective in this frail patient with a giant ASD with pulmonary hyperten- sion and massive pericardial e usion.
Copyright © 2017 Science International Corp.
Key Words:
Atrial septal defect • Pulmonary hypertension • Catheter • Intervention
Introduction
Atrial septal defect (ASD) is a common congenital heart disease in adults. The main indication for ASD clo- sure is the presence of signi cant shunting as evidenced by right heart volume overload with or without symp- toms [1]. Severe xed pulmonary hypertension is con- sidered a contraindication for surgical repair of an ASD [2]. However, development of percutaneous closure techniques and medical management may make secun- dum ASD closure feasible and alleviate symptoms [3].
Case Presentation
An 82-year-old Japanese man su ering from shortness of breath, leg edema, and appetite loss
*Corresponding Author:
Tomohiro Sakamoto, MD
Division of Cardiology
Saiseikai Kumamoto Hospital Cardiovascular Center,
5-3-1 Chikami, Minami-ku, Kumamoto 861-4193, Japan
Tel. +81 96 351 8000; Fax: +81 96 351 8513; E-Mail: tom@kumamoto-u.ac.jp
An 82-year-old man su ering from shortness of breath, leg edema, and appetite loss visited our outpatient clinic. Although he was diagnosed with atrial septal de- fect (ASD) requiring surgical repair 40 years ago, he had refused an operation at that time. Echocardiography re- vealed a 37-mm ASD and massive pericardial e usion. Cardiac catheterization showed signi cant left-to-right shunt ow with Qp/Qs of 4.6 and pulmonary artery pres- sure of 93/35/52 mmHg. Pulmonary vascular resistance was calculated as 8.3 Wood units. Surgical treatment was no longer indicated due to his condition, and per- cutaneous treatment with an Amplatzer septal occluder (ASO) was planned instead. Diuretics, a PDE3 inhibitor and nasal oxygen, were administered preoperatively for 1 month. A 38-mm ASO, the maximum occluder size available in Japan, was implanted successfully. No acute decompensation occurred after ASD closure, and the patient’s symptoms improved after ASO implanta- tion. Cardiac catheterization on postoperative day 13 revealed no evidence of residual shunt, and pulmonary artery pressure decreased to 63/20/33 mmHg. As post- operative therapy, a PDE5 inhibitor, endothelin receptor blocker, and PGI2 analog were administered for residual pulmonary hypertension. Because pericardial e usion did not disappear after pericardiocentesis, surgical peri- cardiostomy was performed 6 months after ASD closure, which reduced PA pressure to 34/16/24. Appropriate
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