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Case 1

History

  • 45 yo female
  • No PMX
  • C/O: Palpitations, chest pain, intermittent dyspnoea
  • O/E: NSR, CVS nil, No LVF/RVF
  • Referred for work-up
  • ECG: NSR
  • Echocardiogram: Dilated RV, mild RA ↑

Findings

  • Differential Dx isolated RV ↑:
    • Pulmonary stenosis
    • Pulmonary regurgitation
    • Pulmonary arterial hypertension
    • VSD
    • ASD
    • Large PE (acute)



Diagnosis

  • Diagnosis: ASD, Sinus Venosus Defect
  • Types: PFO: Normal neonatal shunt, persists in 30% adults, paradox embolus→CVA, assoc migraine
  • Ostium Primum: (20%) anterior + inferior ASD 2o failure endocardial cushion fusion, assoc trisomy 21
  • Ostium Secundum: (70%) most common ASD, occurs in fossa ovalis
  • Sinus Venosus: (10%) Posterior + superior septum near SVC, assoc partial anomalous venous return R sup PV→SVC
  • Coronary Sinus: Defect b/t LA + cor sinus (<1% of ASDs), assoc left SVC

Treatment

  • Percutaneous ASD closure
  • Amplatzer Septal Occluder