Biventricular Interatrial Shunt With Desaturation After Atrial Septal Defect Repair

Patients after atrial septal defect (ASD) repair with residual shunt, elevated pulmonary arterial pressure or arrhythmias, and those repaired at adult age should be followed on a regular basis.

This case describes a 43-year-old female with previous ASD repair, who presented with breathlessness, tiredness, and evidence of desaturation on exercise with a mildly positive bubble echo. While local investigations were inconclusive, diagnostic tests performed at our center revealed an inferior sinus venosus ASD-type defect with bidirectional flow, even though neither right-heart dilatation, pulmonary hypertension nor hemodynamically significant shunt was identified. The patient was offered surgical repair of the residual interatrial communication to give the patient symptomatic benefit.

This case demonstrates a rare presentation of a post-ASD repair patient with bidirectional shunt without right-heart overload and no pulmonary hypertension.

Patients with repaired congenital defects should be followed up by specialized congenital services at reasonable interval based on the lesion and the results of the repair.