Page 37 - Journal of Structural Heart Disease Volume 4, Issue 1

Case Report
Journal of Structural Heart Disease, February 2018, Volume 4, Issue 1:28-32
DOI: https://doi.org/10.12945/j.jshd.2018.036.17
Received: August 09, 2017 Accepted: September 13, 2017 Published online: February 2018
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 Ge en School of Medicine, Los Angeles, California, USA
Abstract
Patients with a signi cant shunt from a secundum atri- al septal defect (ASD) undergo repair to avoid long- term complications of right ventricular failure, atrial arrhythmias, and pulmonary hypertension. Upon sur- gical 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-sid- ed 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 utter. Echocardiography did not demonstrate pericardial ef- fusion, but electrocardiogram-gated cardiac computed tomography angiography showed the right atrial disc digging into the posterior wall of the right atrium. De- spite aggressive medical treatment with non-steroidal anti-in ammatory medication (i.e., opiates and ste- roids), 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 re- covery.
Copyright © 2018 Science International Corp.
Key Words
Atrial septal defect • ASD closure • ASD device retrieval • Congenital heart disease
Introduction
We report a case of a rapid and profound change in the right atrial size of a patient who underwent de- vice closure of a secundum atrial septal defect (ASD) using an Amplatzer septal occluder (ASO) resulting in chest pain and rhythm changes. Computed tomog- raphy angiography (CTA) showed the right atrial disc “digging” into the posterior wall of the right atrium. Upon surgical exposure of the device, the shape and position of the device was found to be distorted.
Case Presentation
A 26-year-old man with a history of a heart mur- mur from the age of 13 was referred to our institution for the management of a newly diagnosed secun-
* Corresponding Author:
Leigh Christopher Reardon, MD
Ahmanson/UCLA Adult Congenital Heart Disease Center and Departement of Pediatric Cardiology
University of California Los Angeles David Ge en School of Medicine
100 UCLA Medical Plaza, Suite 630E, Los Angeles, CA 90024, USA
Tel. +1 310 825 9011; Fax: +1 310 825 6346; E-Mail: lreardon@mednet.ucla.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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http://structuralheartdisease.org/