Case Report
We report a 53-year-old patient with a type II atrial septal defect who underwent defect closure with an Amplatzer Septal Occluder. He presented 20 days after the procedure with acute onset of dyspnoea and hypoxiemia, at which time a transoesophageal echocardiography showed a partially expanded device on the right side of interatrial septum and a decubitus of the device on the right coronary sinus with an aortic-to-left atrial fistula. The patient underwent uneventful surgical device retrieval. Atrial septal defect was closed by Hemapatch and the aorta-to-left atrium fistula was interrupted by a pericardial patch on the aortic side and a suture on the dome of the left atrium.
Patient history prior to current observation :
We report the case of a 53-year-old patient with a type II atrial septal defect who underwent an uneventful interventional defect closure with an Amplatzer Septal Occluder. He was a smoker with recent right pneumonectomy for squamous pulmonary carcinoma.
Clinical findings on admission, evolution and outcome :
He presented 20 days after procedure with acute onset of dyspnoea and hypoxiemia (periferic oxygen saturation of 86%).
Urgent transoesophageal echocardiography showed a partially expanded device on the right side of the atrial septum (fig. 1) with persistent interatrial right-to-left shunt (confirmed by contrast). In addition, a decubitus on the right coronary Valsalva sinus with aortic-to-left atrial fistula was found (fig. 2, fig. 3). Continuous-wave Doppler on the fistula disclosed continuous flow with a maximum gradient of 110 mmHg (fig. 4) coronary sinus with an aortic-to-left atrium fistula.
The patient underwent uneventful surgical device retrieval. Atrial septal defect was closed by Hemapatch and the aorta-to-left atrium fistula was interrupted by a pericardial patch on the aortic side and a suture on the dome of the left atrium.
References
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