A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report

Abstract

Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases and often diagnosed in adulthood. ASD represents a spectrum of disease with symptoms that vary from asymptomatic to right-sided cardiac volume overload, pulmonary arterial hypertension and atrial arrhythmias depending on the size of the defect, size of the shunt and associated anomalies. We reported a patient with large ostium primum ASD who underwent surgical closure with a pericardial patch. Case Description: A 18 years old man came with chief complaint of abnormal ECG results of the screening examination of police candidates from Bhayangkara Hospital Manado. The patient had no complaints during admission. The patient could still carry out daily activities without any obstacles. The patient also could do high intensity sport without complaints of shortness of breath, heavy chest, or headaches. .Electrocardiogram (ECG) examination showed sinus rhythm, heart rate 74 beats per minute, left anterior fascicular block (LAFB), complete right bundle branch block (RBBB) and fragmented QRS at inferior leads. Transthoracic and transesophageal echocardiography revealed large ostium primum ASD L-R shunt.  Open heart ASD surgical closure with pericardial patch was done with good results and no residual shunt. Conclusion: Large ostium primum ASD are associated with significant systemic-to-pulmonary shunts that results in desaturation requiring surgical closure. Large shunt of ASD patients who have a dilated right heart are associated with increased age-related morbidity and mortality. ASD with right heart dilatation should be considered for closure once the diagnosis is established regardless of the patient's age.