Key result
Surgical ASD repair for rare right-to-left shunt with normal PA pressure yields uneventful six-month recovery.
Why the study?
Right-to-left shunting in ASD patients without pulmonary hypertension and tricuspid regurgitation is rare and not well characterized, with limited information available.
Case Report (n=1)
No
Answers are grounded in this paper and cite their sources.
Right-to-left shunting in ASD can occur even with normal pulmonary arterial pressure and may be associated with right ventricular dysfunction.
We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.
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Xu et al. (2023) conducted a case report in Atrial septal defect with right-to-left shunt without pulmonary hypertension (n=1). Atrial septal defect repair and tricuspid valvuloplasty was evaluated on Postoperative recovery and cardiac function. Surgical repair of an atrial septal defect in a patient with a rare right-to-left shunt and normal pulmonary artery pressure resulted in an uneventful recovery and normal left ventricular systolic function at six months.
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