Key result
Transesophageal echocardiography identified a 12-mm atrial septal defect after negative transthoracic echocardiography, and closure with a cocoon device rendered the patient symptom-free.
Why the study?
Marked dyspnoea can be a presentation of undiagnosed atrial septal defect with mild pulmonary hypertension, and transthoracic echocardiography may be negative, posing a diagnostic challenge.
Does transesophageal echocardiography identify undiagnosed atrial septal defect in a patient with marked dyspnea and negative transthoracic echocardiography?
Case Report (n=1)
Does transesophageal echocardiography identify undiagnosed atrial septal defect in a patient with marked dyspnea and negative transthoracic echocardiography?
Transesophageal echocardiography should be considered in patients with marked dyspnea and signs of right heart overload when transthoracic echocardiography is unremarkable, to rule out undiagnosed atrial septal defect.
May support TEE in unexplained dyspnea with right heart overload after negative TTE; hypothesis-generating and should not yet change practice.
A 39-year-old G3P3 female presented with abrupt onset dyspnoea of one month duration. She was markedly symptomatic when lying supine and resorted to prone sleeping. Chest X-ray reported as cardiomegaly. Transthoracic echocardiography was unremarkable twice. Computed tomography chest showed a dilated pulmonary artery. Transesophageal echocardiography identified a 12-mm ostium secundum atrial septal defect with mild pulmonary hypertension. The defect was closed with a cocoon device and rendered her symptom free. This case highlights the importance of timely organization of transesophageal echocardiography when transthoracic echocardiography is negative. It also illustrates marked dyspnoea could be a presentation of undiagnosed atrial septal defect with mild pulmonary hypertension.
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Liyanapathirana et al. (2021) conducted a case report in Atrial septal defect with mild pulmonary hypertension (n=1). Transesophageal echocardiography and defect closure with a cocoon device was evaluated on Symptom resolution. Transesophageal echocardiography identified a 12-mm atrial septal defect after negative transthoracic echocardiography, and closure with a cocoon device rendered the patient symptom-free.
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