Preoperative identification and multidisciplinary management of von Willebrand disease in atrial septal defect...

Von Willebrand disease (VWD) is an inherited bleeding disorder caused by a quantitative or functional deficiency of von Willebrand factor (VWF). We report a 31-year-old male with an atrial septal defect (ASD) whose preoperative coagulation screening revealed mildly prolonged activated partial thromboplastin time (APTT) and reduced factor VIII (FVIII) activity. Further assays confirmed decreased VWF levels, and a detailed bleeding history revealed a significant prior tendency to bleed. A multidisciplinary team (MDT) developed an individualized management plan, including preprocedural cryoprecipitate infusion. The patient subsequently underwent successful ASD closure via interventional occlusion without hemorrhagic complications. This case illustrates that even mildly prolonged APTT in surgical candidates may indicate VWD. A careful bleeding history and targeted laboratory evaluation are essential to avoid missed diagnoses, while individualized perioperative management helps ensure procedural safety. While transcatheter ASD closure is a routine procedure, its occurrence in a patient with newly diagnosed VWD and markedly reduced VWF levels is rarely reported. Transcatheter structural interventions require intraoperative heparinization; therefore, dismissing a mildly prolonged preoperative APTT as clinically insignificant could expose an undiagnosed patient with a bleeding disorder to serious hemorrhagic risk. This case adds new knowledge by illustrating a reproducible diagnostic workflow within a non-hematological cardiac center to avert severe bleeding complications.