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 early
adulthood has a good prognosis, but in older individuals
the risk-benefit ratio is not as straightforward. We report a
57-year-old man who was easily fatigued when
exercising. The cardiac examination revealed a wide and
fixed splitting of S2, a pulmonary ejection systolic murmur
grade III/VI, and increased jugular venous pressure. The
transesophageal echocardiography showed Atrial Septal
Defect secundum with a diameter of 20 mm, L-to-R shunt,
and 5 mm, a thin and floppy inferior rim. The patient
underwent surgical Atrial Septal Defect closure. The
deficient posteroinferior rim occurs only in 3.3% of
patients with secundum Atrial Septal Defect. This
condition will enhance the likelihood of occluder
dislodgement in the transcatheter closure approach. We
learn from this case that surgical Atrial Septal Defect
closure may be an option for elderly patients if there is an
inadequate, thin, and floppy inferior rim or no
comorbidities.
Keywords: Systolic Murmurs, Thoracic Surgical, Vital
Signs, Heart Murmurs, Prognosis