Successful Evolution of Atrial Septal Defect Closure in an Elderly Patient With Complex Cardiovascular Disease

Figures

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  Figure 1. Selective invasive coronary angiography demonstrates an obstructive lesion of the left anterior descending artery (90%) in its proximal segment (arrows, A) which was successfully treated with PCI (arrowhead, B).

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  Figure 2. Two-dimensional TTE-guided M-mode, parasternal long-axis (A) and short-axis (B) views, demonstrate RV dilation and paradoxical movement of the IVS. Subcostal view of the inferior vena cava (C) during inspiration (left) demonstrates less than 50% inspiratory collapse. Right ventricle–focused apical 4-chamber view (D) with color-flow Doppler-guided continuous-wave Doppler, reveals a peak TR velocity of 3.7 m/sec and estimated RV systolic pressure of 70 mm Hg. Ao, Aorta; IVC, inferior vena cava; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

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  Figure 3. Two-dimensional transesophageal echocardiography, orthogonal biplane atrial septal views without (A) and with (B) color-flow Doppler, demonstrates the normal appearing, well-positioned septal occluder device without residual shunting. Three-dimensional transesophageal echocardiography, volume-rendered display of the ostium secundum ASD (C) from the perspective of the RA at baseline (top) and a zoomed, oblique view after repair with a well-positioned septal occluder device (bottom). LA, Left atrium; RA, right atrium.

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  Figure 4. Two-dimensional TTE-guided M-mode, parasternal long-axis view (A) 24 months post-ASD closure, demonstrates normal RV size and interventricular septal motion. Right ventricle–focused apical 4-chamber view (B) with color-flow Doppler-guided continuous-wave Doppler reveals a peak TR velocity of 2.7 m/sec and normal estimated RV systolic pressure. Subcostal view (C) demonstrates a normal diameter of the inferior vena cava with normal inspiratory collapse. LA, Left atrium; LV, left ventricle; RV, right ventricle.