An incidentally discovered atrial septal defect in a patient with pulmonary embolism

Abstract

Background. Atrial septal defects (ASDs) are the most common congenital heart diseases in adults. Patients with ASDs frequently remain undiagnosed until their 5th decade due to their asymptomatic state or indolent symptoms. However, ASDs are best treated when diagnosed early, delayed diagnosis resulting in poor outcomes. Objective(s) of the study: Presentation of the clinical case of a 45-year-old woman with a hemodynamically significant ASD, incidentally diagnosed in the context of an acute pulmonary embolism (PE). Materials and methods. Anamnesis, clinical and paraclinical data were collected from the medical database. Laboratory tests, as well as electrocardiography (ECG), echocardiography (ECHO), computed tomographic (CT) pulmonary angiography and a lower extremity venous Duplex ultrasound (DUS) were performed to establish an accurate diagnosis. Results. The patient presented to the emergency department with complaints of progressive dyspnea, palpitations and fatigue. Though she had been complaining of pain in her left calf for 2 weeks, no diagnostic workup was initiated. ECG: atrial fibrillation, complete right bundle branch block. Severely dilated right chambers, severe tricuspid regurgitation, severe pulmonary hypertension (65 mmHg) and an ASD, ostium secundum type of 16 mm, were noted on her Echo-CG. CT pulmonary angiography confirmed the diagnosis of PE and DUS the presence of deep venous thrombosis. The patient was treated for PE with further recommendations for the closure of the ASD. Conclusion(s). Timely closure of a significant ASD results in better outcomes and lowers cardiac disease burden. Even though PE and ASDs aren’t interdependent, in this case, the acute setting enabled the diagnosis of a significant ASD before the development of irreversible complications.