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.
