Key result
Residual bidirectional interatrial shunt causes exertional desaturation years after initial ASD repair.
Why the study?
Patients after ASD repair with residual shunt, elevated pulmonary arterial pressure, arrhythmias, or repair at adult age require regular follow-up.
Case Report (n=1)
This case highlights the importance of clinical vigilance and multimodality imaging in identifying unusual residual defects, such as a bidirectional shunt facilitated by a prominent Eustachian valve, in adults with previously repaired congenital heart disease.
Answers are grounded in this paper and cite their sources.
May warrant specialized surveillance after ASD repair; leaves open standardized protocols for residual shunt detection.
BACKGROUND: 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. CASE SUMMARY: 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. DISCUSSION: This case demonstrates a rare presentation of a post-ASD repair patient with bidirectional shunt without right-heart overload and no pulmonary hypertension. TAKE-HOME MESSAGE: 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.
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Danylenko et al. (2025) conducted a case report in Residual interatrial communication post-atrial septal defect repair (n=1). Residual interatrial communication was evaluated. A 43-year-old woman with a prior ASD repair was found to have exertional desaturation caused by a rare residual bidirectional interatrial shunt, emphasizing the need for specialized follow-up.
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