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Large fenestrated atrial septal occluder to treat an elderly female in her seventh decade
Anil Kumar Singhi1, Arindam Pande2, Soumya Kanti Mohapatra3, Nandini Biswas4, Arnab De5
1 Department of Pediatric and Congenital Heart Disease, Medica Superspecialty Hospital, Kolkata, West Bengal, India
2 Department of Cardiology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
3 Department of Pediatric Cardiology, Medica Superspecialty Hospital, Kolkata, West Bengal, India
4 Department of Pulmonology, Medica Super Specialty Hospital, Kolkata, West Bengal, India
5 Department of Cardiology, Medica Super Specialty Hospital, Kolkata, West Bengal, India
Correspondence Address:
Anil Kumar Singhi,
Department of Pediatric and Congenital Heart Disease, Medica Superspecialty Hospital, Mukundapur, Kolkata - 700 099, West Bengal
India
 Source of Support: None, Conflict of Interest: None
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Atrial septal defect (ASD) is one of the common congenital heart anomalies presenting in the geriatric group. It presents with symptoms such as progressive effort intolerance, arrhythmias, and palpitations. Sometimes, associated obstructive and restrictive respiratory diseases can contribute significantly to the symptoms masked by cardiac disease. A female in her seventh decade, presenting with dyspnea, had a large ASD with diastolic dysfunction and moderate pulmonary hypertension. She had persistence of symptoms after initial treatment for cardiac elements. On detailed evaluation, she was found to have mixed obstructive and restrictive respiratory disease. She was treated for respiratory elements under expert pulmonology guidance with significant improvement. The ASD was occluded with a custom-made fenestrated 40 mm LifeTech atrial septal occluder in view of diastolic dysfunction and initial pulmonary arterial hypertension. She remained symptomatically better on her short-term follow-up. The index case highlights the importance of detailed evaluation of elderly patients with large ASDs and individualized care to treat.
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