Background: Patients after atrial septal defect (ASD) repair with residual shunt, elevated pulmonary arterial pressure or arrhythmias, and those repaired at adult age should be followed on a regular basis.
Case summary: This case describes a 43-year-old female with previous ASD repair, who presented with breathlessness, tiredness, and evidence of desaturation on exercise with a mildly positive bubble echo. While local investigations were inconclusive, diagnostic tests performed at our center revealed an inferior sinus venosus ASD-type defect with bidirectional flow, even though neither right-heart dilatation, pulmonary hypertension nor hemodynamically significant shunt was identified. The patient was offered surgical repair of the residual interatrial communication to give the patient symptomatic benefit.
Discussion: This case demonstrates a rare presentation of a post-ASD repair patient with bidirectional shunt without right-heart overload and no pulmonary hypertension.
Take-home message: Patients with repaired congenital defects should be followed up by specialized congenital services at reasonable interval based on the lesion and the results of the repair.
Keywords: 3-dimensional imaging; atrial septal defect; congenital heart defect; echocardiography; imaging.
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