A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension

Danfeng Xu; Xuejie Li

doi:doi:10.11648/j.ccr.20230702.12

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A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension

Danfeng Xu, Xuejie Li

Published in Cardiology and Cardiovascular Research (Volume 7, Issue 2)

Received: 12 April 2023 Accepted: 27 April 2023 Published: 10 May 2023

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Abstract

We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.

Published in	Cardiology and Cardiovascular Research (Volume 7, Issue 2)
DOI	10.11648/j.ccr.20230702.12
Page(s)	28-31
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Transesophageal Echocardiography, Atrial Septal Defect, Right-To-Left Shunting, Right Ventricular Function, Pulmonary Hypertension

References

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[2]	Menillo A M, Lee L S, Pearson-Shaver A L. Atrial Septal Defect [M]//StatPearls [Internet]. StatPearls Publishing, 2022.
[3]	Sommer R J, Hijazi Z M, Rhodes J J. Pathophysiology of congenital heart disease in the adult: part I: Shunt lesions [J]. Circulation, 2008, 117 (8): 1090-1099. DOI: 10.1161/CIRCULATIONAHA.107.714402.
[4]	Thomas J D, Tabakin B S, Ittleman F P. Atrial septal defect with right to left shunt despite normal pulmonary artery pressure [J]. J Am Coll Cardiol, 1987, 9 (1): 221-224. DOI: 10.1016/s0735-1097(87)80104-3.
[5]	Godart F, Rey C, Prat A, et al. Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure [J]. Eur Heart J, 2000, 21 (6): 483-489. DOI: 10.1053/euhj.1999.1944.
[6]	Melao F, Cruz C, Noya R, et al. Hypoxia and cyanosis due to unusual right-to-left shunt in a patient with an atrial septal defect [J]. Journal of Cardiovascular Diseases & Diagnosis, 2015.
[7]	Silva M, Teixeira A, Menezes I, et al. Percutaneous closure of atrial right-to-left shunt in patients with Ebstein's anomaly of the tricuspid valve. [J]. Eurointervention: Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2012, 8 (1): 94-97.
[8]	Adolph E A, Lacy W O, Hermoni Y I, et al. Reversible orthodeoxia and platypnea due to right-to-left intracardiac shunting related to pericardial effusion [J]. Annals of internal medicine, 1992, 116 (2): 138-139.
[9]	Berlin D A, Bakker J. Starling curves and central venous pressure [J]. Critical Care, 2015, 19 (1): 1-8.
[10]	Rudski L G, Lai W W, Afilalo J, et al. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography [J]. Journal of the American society of echocardiography, 2010, 23 (7): 685-713.
[11]	Alexandre A, Luz A, de Frias A D, et al. Temporary atrial septal defect balloon occlusion test as a must in the elderly [J]. BMC Cardiovasc Disord, 2023, 23 (1): 15. DOI: 10.1186/s12872-023-03046-9.
[12]	Abdelkarim A, Levi D S, Tran B, et al. Fenestrated Transcatheter ASD Closure in Adults with Diastolic Dysfunction and/or Pulmonary Hypertension: Case Series and Review of the Literature [J]. Congenit Heart Dis, 2016, 11 (6): 663-671. DOI: 10.1111/chd.12367.
[13]	Mercurio V, Palazzuoli A, Correale M, et al. Right heart dysfunction: from pathophysiologic insights to therapeutic options: a translational overview [J]. Journal of Cardiovascular Medicine, 2018, 19 (11): 613-623.
[14]	Puchalski M D, Lui G K, Miller-Hance W C, et al. Guidelines for performing a comprehensive transesophageal echocardiographic: examination in children and all patients with congenital heart disease: recommendations from the American Society of Echocardiography [J]. Journal of the American Society of Echocardiography, 2019, 32 (2): 173-215.
[15]	Miller-Hance W C, Silverman N H. Transesophageal echocardiography (TEE) in congenital heart disease with focus on the adult [J]. Cardiology clinics, 2000, 18 (4): 861-892.

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APA Style

Danfeng Xu, Xuejie Li. (2023). A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiology and Cardiovascular Research, 7(2), 28-31. https://doi.org/10.11648/j.ccr.20230702.12

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ACS Style

Danfeng Xu; Xuejie Li. A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiol. Cardiovasc. Res. 2023, 7(2), 28-31. doi: 10.11648/j.ccr.20230702.12

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AMA Style

Danfeng Xu, Xuejie Li. A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiol Cardiovasc Res. 2023;7(2):28-31. doi: 10.11648/j.ccr.20230702.12

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@article{10.11648/j.ccr.20230702.12,
  author = {Danfeng Xu and Xuejie Li},
  title = {A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {2},
  pages = {28-31},
  doi = {10.11648/j.ccr.20230702.12},
  url = {https://doi.org/10.11648/j.ccr.20230702.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230702.12},
  abstract = {We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.},
 year = {2023}
}

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TY  - JOUR
T1  - A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension
AU  - Danfeng Xu
AU  - Xuejie Li
Y1  - 2023/05/10
PY  - 2023
N1  - https://doi.org/10.11648/j.ccr.20230702.12
DO  - 10.11648/j.ccr.20230702.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 28
EP  - 31
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20230702.12
AB  - We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.
VL  - 7
IS  - 2
ER  -

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Author Information

Danfeng Xu

Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
Xuejie Li

Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China

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Plain Text BibTeX RIS

APA Style

Danfeng Xu, Xuejie Li. (2023). A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiology and Cardiovascular Research, 7(2), 28-31. https://doi.org/10.11648/j.ccr.20230702.12

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ACS Style

Danfeng Xu; Xuejie Li. A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiol. Cardiovasc. Res. 2023, 7(2), 28-31. doi: 10.11648/j.ccr.20230702.12

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AMA Style

Danfeng Xu, Xuejie Li. A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension. Cardiol Cardiovasc Res. 2023;7(2):28-31. doi: 10.11648/j.ccr.20230702.12

Copy | Download

@article{10.11648/j.ccr.20230702.12,
  author = {Danfeng Xu and Xuejie Li},
  title = {A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {2},
  pages = {28-31},
  doi = {10.11648/j.ccr.20230702.12},
  url = {https://doi.org/10.11648/j.ccr.20230702.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230702.12},
  abstract = {We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - A Patient with Right-to-Left Shunt Atrial Septal Defect Without Pulmonary Hypertension
AU  - Danfeng Xu
AU  - Xuejie Li
Y1  - 2023/05/10
PY  - 2023
N1  - https://doi.org/10.11648/j.ccr.20230702.12
DO  - 10.11648/j.ccr.20230702.12
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 28
EP  - 31
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20230702.12
AB  - We present a case of atrial septal defect (ASD) in a 27-year-old young woman who presented with a right-to-left shunt despite normal pulmonary artery pressure without anomalous pulmonary venous drainage and only mild tricuspid regurgitation (TR), but it was associated with right ventricular dysfunction. Considering the dysfunction of the right heart and significant dilatation of the tricuspid annulus, the surgeon still decided to repair ASD and perform tricuspid valvuloplasty. The surgery lasted approximately three hours, and the whole procedure was smooth and uneventful. Her postoperative recovery was uneventful and discharged in good condition. The occurrence of right-to-left (R-L) shunting in patients with ASD is uncommon and is usually an ominous sign, heralding irreversible pulmonary hypertension (PH). There is little information about similar shunts for patients without PH and tricuspid regurgitation (TR), and the majority of these patients have an anatomic anomaly that favors this type of shunt. ASD with R-L shunt without Eisenmenger physiology is rarely reported and may be underestimated due to difficulty in its diagnosis. Intraoperative transesophageal echocardiography (TEE) examination should not only focus on cardiac structure but also the evaluation of ventricular function. Right-to-left shunt is possible in ASD patients even with normal pulmonary arterial pressure.
VL  - 7
IS  - 2
ER  -

Copy | Download