CLOSURE OF AN AGED OSTIUM SECUNDUM ATRIAL SEPTAL DEFECT: WHICH PROCEDURE TO CHOOSE? CASE REPORT AND REVIEW OF THE LITERATURE

Ostium secundum atrial septal defect (OS ASD) is the mostfrequentlydiagnosedcardiac malformation in adulthood. The presence of an ASD iscompletely compatible with a normal life and evenpregnancy. It issometimesdiagnosedduring a work-up for a stroke or at the onset of atrial fibrillation(1). Percutaneousclosureappears to be the preferredapproach for ostium secundum ASD with a favourableanatomicalshape, but surgicalclosureshouldbeconsidered in cases of contraindication, following a detailedpreoperativeassessment (2). The latestrecommendations are strict with regard to establishing the acceptable threshold of pulmonaryarterial pressure (PAP) and pulmonaryvascularresistance (PVR) for closure of the ASD in cases of pulmonaryarterial hypertension (PAH) (3). We report the case of a 61-year-old female patient diagnosedwith an atrial septal defectcomplicated by PAH during a work-up for exertionaldyspnoea. The somaticexaminationwasunremarkable. The ECG showed atrial fibrillation (AF) with a meanventricular rate of 77bpm and complete right bundle branch block. A diagnosis of large (26mm) ostium secondum ASDwas made on transthoracicultrasound (TTU), and transoesophagalultrasound (TOU) ruled out a venous return abnormality. Right heart catheterization revealed a mixed Pulmonary hypertension (PH) withpredominant flow and PVRs of 3-5 WU, allowingpercutaneousclosure. However, the presence of non-ablatable atrial fibrillation and moderatetricuspidinsufficiencycontraindicated the procedure, whichled to surgicalclosureusing an autologouspericardial patch combinedwith a DE VEGA-type tricuspidannuloplasty, with a simple postoperative course.