Atrial Septal Defect in a Young Boy Presenting With a Rare Crochetage Sign: A Case Report

An atrial septal defect (ASD) is a common congenital heart anomaly that results in irregular blood flow between the systemic and pulmonary circulations due to an opening in the atrial septum. Ostium secondum ASD accounts for a large proportion of these defects and often goes unnoticed during childhood and adolescence. Pulmonary hypertension (PH), affecting a significant number of patients with ostium secondum ASD, is associated with functional limitations, heart failure, and tachyarrhythmias. This case involves a 23-year-old male with a large ostium secondum ASD, moderate PH, and normal left ventricular systolic function, presenting with a rare Crochetage sign on his electrocardiogram (ECG). The patient's clinical presentation, including the presence of the Crochetage sign, was assessed using various diagnostic tools. An ECG identified the characteristic notch in the R wave in the inferior leads, indicative of ASD. Further evaluation, including echocardiography, was performed to assess the size and impact of the ostium secondum ASD. Echocardiography confirmed the presence of a large ASD with moderate PH. The case underscores the importance of recognizing rare signs, like the Crochetage sign, in the diagnosis and management of ASD. It presents a clinical dilemma regarding whether to proceed with the closure of the ostium secondum, given the potential complications associated with complete closure. A multidimensional approach, considering the patient's overall condition and potential risks, is essential for optimal management. This case highlights the need for comprehensive evaluation and timely intervention to improve outcomes in patients with ASD.