Percutaneous residual interatrial communication device closure in adult Ebsteins anomaly with hypoxemia: Post Hoc, Ergo Propter Hoc

Tóm tắt

Background

A 25-year old female patient with congenital heart disease - Ebstein's anomaly with concomitant ASD, S/P Tricuspid valve replacement and partial patch closure of the interatrial communication, presenting with desaturation and heart failure symptoms one month post surgery.  The patient underwent TEE which revealed a small echo drop out measuring 0.4 cm at the superior and posterior portion of the interatrial septum, a continuous wave doppler showed a tricuspid valve gradient of 5 mmHg, with the interatrial septum bulging into the LA , signifying pressure overload in the RA.  Cardiac catheterization showed pressure difference between the RA and the RV during diastole.  The pressure gradient was more than 5mmHg which is indicative of prosthetic valve dysfunction, some form of valve obstruction secondary to probable thrombus formation on the biosprosthetic valve in the tricuspid position.  Oximetry showed significant step-down of oxygen saturation at the level of the LUPV to LA, consistent with a right-to-left shunt.  Amelioration of symptoms occurred after performing percutaneous device closure of the residual shunt using a PFO occluder.

Methods

Echocardiography and cardiac catheterization afforded the attending physicians a much clearer picture of the patient's condition and were pivotal in the decision to pursue percutaneous device closure of the residual shunt.

Results

Percutaneous device closure of the residual interatrial connection provided relief of the manifestations of the patient.

Conclusion

In conclusion, Ebstein’s anomaly is rare, and its management can be challenging, as with this case. An anecdotal approach was adopted with tremendous clinical outcomes.