PMC9489849_01
Left heart disease progression after ASD closure. Serial chest radiographs (arrows indicated the timeline of CXR) and heart failure markers (NT proBNP & Echocardiography) before and after ASD closure. (A) CXR: cardiomegaly, moderate right-side pleural effusion, and bilateral lung congestion (B) CXR: pleural effusion and lung congestion improved after diuretics (C) CXR: minimal pericardial effusion (triangle) 2.5 months after closure, arrowhead: ASD occluder (D) CXR: evident right pleural effusion (asterisk) with increased lung congestion 8 months after closure, arrowhead: ASD occluder. NT-pro BNP initial drop following ASD closure, gradually re-climbed 14-20 months later. Note that the climbing velocity is slower than that seen before ASD closure. In addition to the improving hyperdynamic LVEF and progressive enlarged LA volume, the other echocardiography parameter seems to have no significant change during the 20-month follow-up. ASD denotes atrial septal defect; CXR, chest X-ray; NT-pro BNP, N-terminal pro-brain natriuretic peptide; LVEF, left ventricular ejection fraction; LAEDVI, left atrial end-diastolic volume index; MV, mitral valve; DecT, deceleration time; LVID, left ventricular internal diameter; NYHA Fc, New York Heart Association Functional class.
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F1
Chest radiography revealed an enlarged cardiac profile and lung congestion (Figure 1, Panel A). After heart failure was controlled with intravenous diuretic medication, cardiomegaly improved (Figure 1, Panel B), NT-pro BNP levels decreased (Figure 1, 7,790 to 1,904 pg/mL), and lower limb edema reduced. However, with time, the heart failure worsened (Figure 1, NT proBNP).
Residual ASD shunt. Transthoracic echocardiography demonstrated residual shunting (arrow) through the waist of the ASD device. ASD denotes atrial septal defect; CTS denotes cor triatriatum sinister; LA denotes left atrium.
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F2
The patient eventually underwent transcutaneous ASD closure using an 18-mm Amplatzer septal occluder, following which trivial residual interatrial shunting was detected on color Doppler echocardiography (Figure 2).