A case of successful treatment of a patient with high pulmonary hypertension by implantation of an occluder in an atrial septal defect

Aim: the purpose of this publication is to demonstrate the safety and efficacy of the endovascular method of treatment for long-existing, neglected, and fairly common congenital heart defects such as an atrial septal defect with high pulmonary hypertension.Material and Methods. We present a clinical case of the successful X-ray endovascular treatment of a 48-year-old female patient with a high pulmonary hypertension diagnosed with congenital heart disease, atrial septal defect. Clinical and instrumental examination included standard resting electrocardiography, echocardiography, and catheterization of the right heart and the pulmonary artery. Surgical treatment consisted in an X-ray endovascular implantation of the 40-mm atrial septal defect closure device via the transfemoral access. Post-operative follow up care lasted for 15 months.Results. Echocardiography study showed the left ventricular ejection fraction of 53 mL; congenital heart disease was characterized by 2.5-cm secondary central atrial septal defect and a variable pressure release. Pulmonary artery systolic pressure was 120 mmHg. Catheterization of the right heart and the pulmonary artery showed blood flow with the presence of leftto-right shunting equal to Qp/Qs=2.0/1. An X-ray endovascular atrial septal defect surgery was conducted in an X-ray operation room via a standard transfemoral access. The surgery consisted in X-ray endovascular atrial septal defect occlusion with an implantation of an atrial septal defect closure device with 40-mm neck diameter. Intraoperative echocardiography study showed that the closure device was placed correctly with no signs of residual bleeding. The final echocardiography performed in three days showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 83 mmHg. Hospital stay lasted for three days. Follow-up echocardiography study at 15 months showed the condition after atrial septal defect closure device implantation. The defect was tightly closed. Pulmonary artery systolic pressure was 46 mmHg.Conclusion. There are currently two types of treatment: open surgery such as suturing or plastic urgery with extracorporeal blood circulation and X-ray endovascular occlusion of the atrial septal defect by implantation of a special device. The X-ray endovascular treatment of an atrial septal defect with a closure device implantation is a highly effective and safe procedure. The main advantages of this method are as follows: surgery does not require anesthesia, incision, and heart-lung bypass whereas reimplantation and repositioning of the device is always feasible.