A hol(e)y predicament

Area of Science:

• Cardiology
• Congenital Heart Disease

Background:

• Endocardial cushion defects are congenital heart abnormalities affecting septa and valves.
• Typically diagnosed in infancy, late presentation is uncommon.

Observation:

• A 72-year-old female presented with dyspnea and palpitations.
• She experienced cardiac arrest due to refractory hypoxemia, requiring mechanical ventilation and inhaled nitric oxide.
• Echocardiography revealed a large ostium primum atrial septal defect (ASD) with Eisenmenger syndrome.

Findings:

• The patient's arrhythmia was likely a sequela of her long-standing congenital ASD.
• This led to sudden decompensation and cardiac arrest.

Implications:

• This case underscores the potential for late-onset complications from congenital heart defects.
• Reviews the etiology, presentation, and complications of ASDs, emphasizing rare late-life manifestations.