Key result
3D TEE accurately identifies complex multi-hole secundum ASD with 5 defects to guide surgical repair.
Why the study?
Multi-hole ostium secundum atrial septal defect is rare and presents diagnostic and therapeutic challenges that require detailed assessment and appropriate management strategies.
Case Report (n=1)
3D transesophageal echocardiography is essential for detailed assessment of the interatrial septum in multi-hole ostium secundum ASD, which typically requires surgical closure rather than device closure.
May inform closure decisions in select complex ASD cases; leaves open routine adoption pending larger studies.
Atrial Septal Defect (ASD) is the third most common congenital heart defect.There are three main types of ASD: ostium secundum, ostium primum and sinus venous.There are few reports of multi-hole ostium secundum ASD, its incidence is estimated in 4-10%.A 56-year-old male attends to medical consultation due to three-month exertional dyspnea, palpitations and lower limb edema.Transthoracic echocardiogram reported dilatation of right cavities, ostium secundum ASD, severe tricuspid insufficiency, pulmonary hypertension, left ventricular ejection fraction of 60%.A cardiac examination with arrhythmic heart sounds, splitting of the second sound and systolic murmur in second right intercostal space.Electrocardiogram showed atrial fibrillation and incomplete right bundle branch block.The 2D and 3D transesophageal echocardiogram confirmed the presence of multi-hole ostium secundum ASD.Right heart catheterization showed mild pulmonary hypertension.Surgical management was suggested to correct the multi-hole ASD.The diagnosis of the ASD should always include a 3D transesophageal echocardiogram for a detailed assessment of the interatrial septum.Complex multi-hole ostium secundum ASD is a relative contraindication for closure with an Amplatzer device; therefore, a surgical treatment with opened exposure should be done.
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Álvarez-Santana et al. (2020) conducted a case report in Multi-hole ostium secundum Atrial Septal Defect (n=1). 3D transesophageal echocardiogram was evaluated. Three-dimensional transesophageal echocardiography accurately diagnosed a complex multi-hole ostium secundum atrial septal defect with at least 5 holes, guiding the decision for surgical closure.
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