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Título

Secundum Atrial Septal Defect and Patent Ductus Arteriosus in an elderly woman: A Case-Based Update

Resumo

INTRODUCTION: Atrial Septal Defect (ASD) is the most common congenital heart lesion in adults, with secundum ASD representing 70 to 75 percent of all ASDs, and Patent Ductus Arteriosus (PDA) occurring when the ductus arteriosus, a fetal vascular connection between the main pulmonary artery and the aorta, fails to completely close postnatally. The diagnosis of the association between secundum ASD and PDA is rare in the elderly, with few reports in the literature. Herein, we report a diagnosis of secundum ASD and PDA in an elderly woman.
CASE DESCRIPTION: A 68-year-old woman, previously healthy, with a history of progressive and insidious exercise intolerance, fatigue, dyspnea, and onset hypertension three months ago. Cardiovascular exam revealed tachycardia, low systemic oxygen saturation, and a continuous murmur (grade 2/6) on auscultation. Electrocardiogram showed sinus rhythm, and Transesophageal Echocardiography (TEE) revealed a secundum ASD and small PDA, along with pulmonary hypertension (Pulmonary Artery Systolic Pressure estimated at 56 mmHg). Subsequently, the patient underwent percutaneously ASD closure and transcatheter occlusion for PDA, experiencing significant improvement in cardiovascular symptoms. The patient had no post-intervention complications, and Transthoracic Echocardiography demonstrated resolution of pulmonary hypertension.
DISCUSSION: The clinical manifestations of a PDA and ASD are determined by the degree of left-to-right shunting. Small shunting is commonly identified incidentally, and patients are asymptomatic. Exercise intolerance, fatigue, and dyspnea are common clinical manifestations of ASDs and PDA in adults. The diagnosis of both pathologies is confirmed by echocardiography; chest radiographs and electrocardiograms may be helpful but are less sensitive and specific. Interventions for PDA closure include pharmacologic therapy, which is used exclusively in premature infants, transcatheter catheter occlusion, and surgical ligation. Treatment options for most secundum ASDs include percutaneous closure or surgical repair.
CONCLUSIONS: Although rare in the elderly, the association between ASD and PDA must be recognized and diagnosed because they can evolve with complications such as atrial arrhythmias, pulmonary hypertension (case of our patient), Eisenmenger syndrome, paradoxical embolism, and cyanosis. Thus, early diagnosis and timely repair of ASD and PDA represent a better prognosis.

Palavras Chave

Secundum Atrial Septal Defect; Patent Ductus Arteriosus; elderly

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