Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report
Atrial Septal Defect closure in childhood and early adulthood has a good prognosis, but in older individuals the risk-benefit ratio is not as straightforward. We report a 57-year-old man who was easily fatigued when exercising. The cardiac examination revealed a wide and fixed splitting of S2, a pu...
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| Format: | Article |
| Language: | English |
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Pakistan Medical Association
2024-07-01
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| Series: | Journal of the Pakistan Medical Association |
| Online Access: | https://jpma.org.pk/index.php/public_html/article/view/21462 |
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| author | Irawati Hajar Kikuko Achmad Lefi Steve Freyssinet Karundeng Agus Subagjo A’ Rofah Nurlina Puspitasari Alqi Yutha |
| author_facet | Irawati Hajar Kikuko Achmad Lefi Steve Freyssinet Karundeng Agus Subagjo A’ Rofah Nurlina Puspitasari Alqi Yutha |
| author_sort | Irawati Hajar Kikuko |
| collection | DOAJ |
| description |
Atrial Septal Defect closure in childhood and early
adulthood has a good prognosis, but in older individuals
the risk-benefit ratio is not as straightforward. We report a
57-year-old man who was easily fatigued when
exercising. The cardiac examination revealed a wide and
fixed splitting of S2, a pulmonary ejection systolic murmur
grade III/VI, and increased jugular venous pressure. The
transesophageal echocardiography showed Atrial Septal
Defect secundum with a diameter of 20 mm, L-to-R shunt,
and 5 mm, a thin and floppy inferior rim. The patient
underwent surgical Atrial Septal Defect closure. The
deficient posteroinferior rim occurs only in 3.3% of
patients with secundum Atrial Septal Defect. This
condition will enhance the likelihood of occluder
dislodgement in the transcatheter closure approach. We
learn from this case that surgical Atrial Septal Defect
closure may be an option for elderly patients if there is an
inadequate, thin, and floppy inferior rim or no
comorbidities.
Keywords: Systolic Murmurs, Thoracic Surgical, Vital
Signs, Heart Murmurs, Prognosis
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| format | Article |
| id | doaj-art-b396f43bb2064d93804f1b43cdd8ef8a |
| institution | DOAJ |
| issn | 0030-9982 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | Pakistan Medical Association |
| record_format | Article |
| series | Journal of the Pakistan Medical Association |
| spelling | doaj-art-b396f43bb2064d93804f1b43cdd8ef8a2025-08-20T02:41:40ZengPakistan Medical AssociationJournal of the Pakistan Medical Association0030-99822024-07-01746 (Supple)10.47391/JPMA.S6-ACSA-15Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case reportIrawati Hajar Kikuko0Achmad Lefi1Steve Freyssinet Karundeng2Agus Subagjo3A’ Rofah Nurlina Puspitasari4Alqi Yutha5Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia.Department of Cardiology & Vascular Medicine, Dr Soetomo General Hospital, Indonesia. Atrial Septal Defect closure in childhood and early adulthood has a good prognosis, but in older individuals the risk-benefit ratio is not as straightforward. We report a 57-year-old man who was easily fatigued when exercising. The cardiac examination revealed a wide and fixed splitting of S2, a pulmonary ejection systolic murmur grade III/VI, and increased jugular venous pressure. The transesophageal echocardiography showed Atrial Septal Defect secundum with a diameter of 20 mm, L-to-R shunt, and 5 mm, a thin and floppy inferior rim. The patient underwent surgical Atrial Septal Defect closure. The deficient posteroinferior rim occurs only in 3.3% of patients with secundum Atrial Septal Defect. This condition will enhance the likelihood of occluder dislodgement in the transcatheter closure approach. We learn from this case that surgical Atrial Septal Defect closure may be an option for elderly patients if there is an inadequate, thin, and floppy inferior rim or no comorbidities. Keywords: Systolic Murmurs, Thoracic Surgical, Vital Signs, Heart Murmurs, Prognosis https://jpma.org.pk/index.php/public_html/article/view/21462 |
| spellingShingle | Irawati Hajar Kikuko Achmad Lefi Steve Freyssinet Karundeng Agus Subagjo A’ Rofah Nurlina Puspitasari Alqi Yutha Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report Journal of the Pakistan Medical Association |
| title | Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report |
| title_full | Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report |
| title_fullStr | Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report |
| title_full_unstemmed | Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report |
| title_short | Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report |
| title_sort | atrial septal defect secundum with inferior floppy rim in the elderly surgical closure or transcatheter closure a case report |
| url | https://jpma.org.pk/index.php/public_html/article/view/21462 |
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