Third time lucky: challenging secundum atrial septal defect.

Area of Science:

• Cardiology
• Cardiac Surgery
• Internal Medicine

Background:

• Secundum atrial septal defects (ASDs) are the most frequent type of interatrial communication.
• While often asymptomatic in youth, ASDs can manifest with exertional dyspnea, palpitations, or stroke.
• Severe presentations like heart failure or resting desaturation are uncommon in young patients.

Observation:

• A young male patient presented with a secundum ASD.
• The patient underwent two unsuccessful surgical corrections for the ASD.
• Constrictive pericarditis was diagnosed late in the clinical course.

Findings:

• The diagnosis of constrictive pericarditis was established after two failed ASD surgical attempts.
• A third surgical intervention, pericardiectomy, was performed.
• The patient experienced significant symptomatic improvement post-pericardiectomy.

Implications:

• This case underscores the importance of considering rarer diagnoses, such as constrictive pericarditis, in young adults with complex cardiac conditions.
• It highlights diagnostic challenges and the potential need for multi-stage surgical interventions in intricate cases of ASD.
• Successful pericardiectomy suggests its utility in managing combined ASD and constrictive pericarditis, improving patient outcomes.