Double Intervention in Single Sitting: Percutaneous Device Closure and Permanent Pacemaker Implantation in a Patient with Atrial Septal Defect

Raghu Cherukupalli¹, Shawkat Miro¹, Srinivas Movva¹, Prashant Patil¹, Nirlep Gajiwala², Ashok Thakkar²

¹Department of Cardiology, Prime Hospitals, Hyderabad, India.
²Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd., Surat, India.

DOI: 10.4236/ijcm.2014.520167                

Abstract

Context: Atrial septal defect may rarely be associated with other cardiac diseases such as arrhythmia, and may require additional intervention. Case report: A 16-year-old boy presented with effort dyspnea, tiredness, and fatigue. The electrocardiograph revealed right bundle branch block, atrioventricular block, and left axis deviation. Ostium secundum type of atrial septal defect was detected by transthoracic echocardiography and was confirmed by transesophageal echocardiography. The patient was advised to undergo percutaneous device closure. Permanent pacemaker implantation was also suggested considering the risk of fatal arrhythmias associated with atrioventricular block. Consequently, patient underwent percutaneous atrial septal defect closure and implantation of pacemaker in a single sitting. Both the procedures were successful, after which the patient showed remarkable symptomatic improvement. Conclusion: In atrial septal defect patients with unexplained atrioventricular block, closure of atrial septal defect and implantation of pacemaker in single sitting appear to be an attractive modality.

Keywords

Atrial Septal Defect, Ostium Secundum, Pacemaker, Percutaneous Device Closure, Double Intervention in Single Sitting

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sarkozy, A., Conti, E., Neri, C., D’Agostino, R., Digilio, M.C., Esposito, G., Toscano, A., Marino, B., Pizzuti, A. and Dallapiccola, B. (2005) Spectrum of Atrial Septal Defects Associated with Mutations of NKX2.5 and GATA4 Transcription Factors. Journal of Medical Genetics, 2, e16. http://dx.doi.org/10.1136/jmg.2004.026740
[2]	Horvath, K.A., Burke, R.P., Collins Jr., J.J. and Cohn, L.H. (1992) Surgical Treatment of Adult Atrial Septal Defect: Early and Long-Term Results. Journal of the American College of Cardiology, 5, 1156-1159. http://dx.doi.org/10.1016/0735-1097(92)90372-T
[3]	Kazmi, T., Sadiq, M., Asifur, R., Hyder, N. and Latif, F. (2009) Intermediate and Long-Term Outcome of Patients after Device Closure of ASD with Special Reference to Complications. Journal of Ayub Medical College Abbottabad, 3, 117-121.
[4]	Seldinger, S.I. (1953) Catheter Replacement of the Needle in Percutaneous Arteriography; a New Technique. Acta Radiologica, 5, 368-376. http://dx.doi.org/10.3109/00016925309136722
[5]	Emanuel, R., O’Brien, K., Somerville, J., Jefferson, K. and Hegde, M. (1975) Association of Secundum Atrial Septal Defect with Abnormalities of Atrioventricular Conduction or Left Axis Deviation. Genetic Study of 10 Families. Br Heart J, 10, 1085-1092. http://dx.doi.org/10.1136/hrt.37.10.1085
[6]	Friedman, R.A., O’Laughlin, M.P., Moak, J.P., Perry, J.C., Mullins, C.E., Garson Jr., A. and Feltes, T.F. (1994) Successful Closure of a Previously Unsuspected Atrial Septal Defect by an Implantable Clamshell Device and Subsequent Transvenous Pacemaker Implantation. Texas Heart Institute Journal, 2, 161-165.
[7]	Bitar, A., Dorotan-Guevara, M.M., Lucas, V. and Snyder, C.S. (2010) Implantation of Cardioverter Defibrillator after Percutaneous Closure of Atrial Septal Defect. The Ochsner Journal, 1, 27-31.