Source: Annual Congress 2001 - Disease of the pulmonary circulation
Disease area: Pulmonary vascular diseases

Abstract

A 78 year old woman presented with a first episode of a syncope. She reported increasing chest pain, fatigue and dyspnea upon exertion over the course of two month prior to admission.
Auscultation revealed fixed doubling of the second heart sound. Serum acute phase proteins and liver enzymes were moderately elevated. Chest X-ray showed an extremely enlarged right heart and dilated pulmonary artery of 2 cm. Echocardiography revealed an atrial septal defect of 3 cm in diameter and a mean PAP of 75 mmHg.
Neurological and other causes for a sudden loss of conscious were excluded and the episode was attributed to the severe pulmonary hypertension with intermittent insufficient cerebral perfusion.
The ASD was closed by means of an interventional closure device ( Fa. Amplatzer). 4 weeks later, echokardiography resulted in an estimated PAP of 28 mmHg (inclusive central venous pressure). The patients condition increased and no further syncope was reported.
This case is remarkable in that very large ASD was asymptomatic up into old age and was not followed by shunt inversion. Noninvasive closure is a good alternative or surgery in this situation in elderly.

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V. F. H. Brauer, C. Gessner, J. Winkler, A. Hagendorff, D. Pfeiffer, H. Wirtz (Leipzig, Germany). A large ostium secundum type atrial septal defect as a course for a syncope in a 78-year-old female. Eur Respir J 2001; 16: Suppl. 31, 3516

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