Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report

Abstract

Atrial Septal Defect closure in childhood and earlyadulthood has a good prognosis, but in older individualsthe risk-benefit ratio is not as straightforward. We report a57-year-old man who was easily fatigued whenexercising. The cardiac examination revealed a wide andfixed splitting of S2, a pulmonary ejection systolic murmurgrade III/VI, and increased jugular venous pressure. Thetransesophageal echocardiography showed Atrial SeptalDefect secundum with a diameter of 20 mm, L-to-R shunt,and 5 mm, a thin and floppy inferior rim. The patientunderwent surgical Atrial Septal Defect closure. Thedeficient posteroinferior rim occurs only in 3.3% ofpatients with secundum Atrial Septal Defect. Thiscondition will enhance the likelihood of occluderdislodgement in the transcatheter closure approach. Welearn from this case that surgical Atrial Septal Defectclosure may be an option for elderly patients if there is aninadequate, thin, and floppy inferior rim or nocomorbidities.Keywords: Systolic Murmurs, Thoracic Surgical, VitalSigns, Heart Murmurs, Prognosis