Page 38 - Journal of Structural Heart Disease Volume 4, Issue 1

29 Case Report
Figure 1. Chest X-rays demonstrating (Panel A) signi cant right atrial enlargement secondary to the patient’s large secundum atrial septal defect (Panel A) and profound decrease in right atrial size 12 days after device placement (Panel B).
dum ASD. The patient initially presented to his prima- ry doctor after a several-month history of decreased exercise tolerance and palpitations. On transthoracic echocardiogram, the patient was noted to have pro- found right atrial and right ventricular enlargement and a large ASD measuring 1.8 × 2.2 cm. Electrocar- diogram (ECG) demonstrated a low atrial rhythm with a rate of 48 beats per minute and an Rsr’ in the lead V1. A chest X-ray demonstrated severe right atrial en- largement (Figure 1A).
Video 1. Balloon-sizing of the atrial septal defect using a 34-mm sizing balloon. Despite stop- ow, there was no waist on the sizing balloon. View supplemental video at https://doi.org/10.12945/j. jshd.2018.036.17.vid.01.
In the catheterization lab, hemodynamic data demonstrated a normal pulmonary vascular resis- tance of 0.4 Wood units and a Qp:Qs of 2.7:1. Trans- esophageal echocardiography showed that the de- fect measured 30 mm, and the stop- ow technique using a 34-mm-sized balloon did not demonstrate a waist on cineangiogram, so a 38-mm Amplatzer ASO device was chosen. An excellent result was achieved with both imaging modalities. Videos 1 and 2 show balloon-sizing of the defect and rotational angiog- raphy of the device in excellent position. The patient
Video 2. Rotational cineangiogram after device deployment demonstrated excellent positioning of the device. View sup- plemental video at https://doi.org/10.12945/j.jshd.2018.036.17. vid.02.
Reardon L. C. et al.
Rapid Right Atrial Reduction after ASD Closure