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Secundum ASD--not for closure.

Naresh Kumar Goyal1, Hemant Behera, Shyam S Kothari

  • 1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.

Indian Heart Journal
|October 4, 2005
PubMed
Summary
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A patient with an atrial septal defect experienced hemodynamic decline during a closure attempt. Subsequent tests revealed primary cardiac amyloidosis as the underlying cause.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Cardiac Imaging

Background:

  • Atrial septal defects (ASDs) are common congenital heart conditions.
  • Hemodynamic compromise can occur in patients with large or complex ASDs.
  • Primary cardiac amyloidosis is a rare infiltrative cardiomyopathy.

Observation:

  • A 32-year-old male presented with a 17 mm secundum atrial septal defect.
  • The patient exhibited significant hemodynamic deterioration during temporary balloon occlusion of the ASD.
  • The planned defect closure was aborted due to the patient's instability.

Findings:

  • Further diagnostic workup, including advanced cardiac imaging and potentially biopsy, was performed.
  • The investigation identified primary cardiac amyloidosis as the cause of the patient's condition.

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  • The amyloid deposition likely contributed to the intolerance of even temporary hemodynamic changes.

    • Implications:

    • This case highlights the importance of considering infiltrative cardiomyopathies in patients with seemingly simple structural heart disease who exhibit unexpected instability.
    • Early diagnosis of primary cardiac amyloidosis is crucial for appropriate management and prognosis.
    • Understanding the interplay between structural defects and infiltrative diseases is vital for cardiovascular clinicians.