SESSION TYPE: Heart Failure
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Atrial septal defects (ASD) and patent foramen ovale (PFO) are the most common adult congenital heart disorders. A common indication for ASD closure is right ventricular enlargement. We report our experience with a cohort of patients who presented with unexplained shortness of breath and hypoxia.
METHODS: We performed retrospective chart review of patients with ASD/PFO who presented with hypoxia or dyspnea on exertion and were referred to our pulmonary hypertension clinic from January 2010 to February 2012.
RESULTS: We identified 15 patients (12 female), ages 15-78 (female mean age, 56; male mean age, 67). Seven patients (46.7%) had a tunnel PFO (four with right-to-left shunting, three with bidirectional shunting). Eight patients (53.3%) had ASD (one sinus venosus, seven secundum). Of the seven patients with a secundum ASD, five had left-to-right shunting and two had bidirectional shunting. Baseline functional status was NYHA Class IV in three patients (20%), Class III in 11 (73.3%) and Class II in one (6.7%). Five patients (33.3%) required continuous-flow oxygen. Five patients (33.3%) had severe pulmonary hypertension at diagnosis. Fourteen patients (93.3%) underwent percutaneous closure; one (6.7%) underwent surgical closure. All patients had improvement in NYHA class. Four out of five (80%) oxygen-dependant patients were taken off oxygen, and one had a decrease in oxygen requirement. All five pulmonary hypertension patients were weaned off associated medications. Follow-up echocardiography showed no evidence of residual shunts. One patient with syncope had complete resolution of her symptoms.
CONCLUSIONS: There is a subset of patients with atrial level shunts who present with disproportionate hypoxia or shortness of breath. In these patients, careful evaluation should include a transesophageal echocardiography with saline contrast imaging and exercise hemodynamics. In our cohort, closure of the atrial shunt led to absolute resolution of their signs and symptoms, improvement in the NYHA class, decrease in oxygen requirements and resolution of pulmonary hypertension.
CLINICAL IMPLICATIONS: Patients with atrial shunts and dyspnea require additional evaluations as they frequently can be cured by closure.
DISCLOSURE: The following authors have nothing to disclose: Krishna Nagendran, Bijoy K. Khandheria, Tanvir Bajwa, Suhail Allaqaband, Mary E. Wenzel, A. Jamil Tajik, Dianne Zwicke
No Product/Research Disclosure InformationAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI