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SUCCESFUL TREATMENT OF A BIDIRECTIONAL SHUNT - A CASE REPORT

Rene-Alexander Starick, Laura Verna, Dilyana Tonkova, Stanislava Ivanova, Dobrin Kalchev

Abstract

Introduction: Secundum atrial septal defects are some of the most common congenital heart defects. The placement of an Amplatzer Septal Occluder to close the atrial septal defect (ASD) is performed to treat the defect. A 45-year-old woman was admitted at the St. Marina University Hospital in Varna, Bulgaria with a diagnosis of ASD type II, which was already made at the Charité Hospital in Berlin, Germany. She was treated there for AV nodal reentry tachycardia and respiratory infection two years ago and with bidirectional shunting across the defect.

Materials and methods: Over a course of two months the patient received loop diuretics (Torasemide), reducing preload and afterload, as well as Fostair 100/6 (Beclometasone + Formoterol) to treat the respiratory symptoms. Finally, contrast echocardiography showed no bidirectional shunting and interventional procedure of device closure of the ASD was undertaken, making use of the Amplatzer Septal Occluder. NT-pro-BNP levels, before the closure of the defect, were elevated and afterwards, on follow-up on day 7 and day 30, they were close to normal range.

Results: After two months, the patient showed significant improved performance, decreased biomarkers and no left to right shunting on colour Doppler. The increased blood flow to the right heart lead to pulmonary hypertension predisposing the patient to respiratory tract infections. In order to effectively treat the patient with elevated pressure of the right heart, pretreatment with diuretics and brochoactive drugs was necessary.

Conclusion: Successful placement of an Amplatzer Septal Occluder to close the ASD II was performed after pretreatment of the patient.


Keywords

atrial septal defects (ASD), loop diuretics, Amplatzer Septal Occluder


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