[Incidental diagnosis of an ostium-secundum-type interatrial communication during coronary surgery]

Area of Science:

• Cardiology
• Cardiac Surgery
• Medical Diagnostics

Background:

• A 73-year-old woman presented for coronary revascularization with severe triple-vessel coronary artery disease.
• Preoperative assessment indicated mild mitral and moderate tricuspid insufficiency, alongside moderate-to-severe pulmonary hypertension.
• Left ventricular function was preserved, with no initial suspicion of intracardiac shunting.

Observation:

• Intraoperative pulmonary artery catheterization revealed elevated pulmonary hypertension and unexpectedly high cardiac output.
• Blood gas analysis showed a significant increase in PO2 and oxygen saturation from peripheral veins to the right atrium.
• These findings raised suspicion for an undiagnosed atrial septal defect.

Findings:

• Intraoperative echocardiography confirmed a 3 cm ostium secundum atrial septal defect.
• The atrial septal defect was surgically closed concurrently with coronary artery bypass grafting.
• Post-closure, oximetric measurements normalized, and pulmonary artery pressures decreased.

Implications:

• This case underscores the critical role of invasive hemodynamic monitoring and transesophageal echocardiography during cardiac surgery.
• Intraoperative diagnostics can reveal unexpected intracardiac defects missed in preoperative evaluations.
• Prompt identification and management of such defects are crucial for optimizing surgical outcomes and patient recovery.