Concomitant Discovery and Treatment of Acquired and Congenital Cardiac Disease

Coexisting coronary artery disease (CAD) and congenital heart disease (CHD) is rare in adults and poses complex management challenges requiring multidisciplinary coordination.

A 79-year-old man with a history of CAD and stenting was referred for evaluation given worsening dyspnea. Coronary angiography revealed severe ostial left circumflex stenosis and moderate left main disease. In addition, computed tomography demonstrated a previously undiagnosed sinus venosus atrial septal defect with partial anomalous pulmonary venous return. Multidisciplinary evaluation at a partnering CHD program recommended staged percutaneous revascularization and transcatheter closure of the defect instead of surgical repair on cardiopulmonary bypass. The patient successfully underwent complex stenting of the CAD and subsequent transcatheter closure of the sinus venosus atrial septal defect with implantation of a 5.7-cm, 10-zig G-Armor covered stent within the superior vena cava. The procedures were well tolerated without complications, and the patient reported improvement in symptoms on follow-up evaluation.

Multidisciplinary percutaneous strategies can achieve effective revascularization and repair of complex coexisting CAD and CHD, avoiding high-risk surgical intervention. Growth in the complexity of CHD patients mandates expanded understanding of comprehensive percutaneous approaches. The hub-spoke model of adult CHD care can optimize treatment for these patients.