PMC9988386_01
(a) CMR four-chamber view demonstrating dilated right heart with a 21 mm ASD (arrow). (b) CMR short-axis view demonstrating a 21 mm ASD (arrow). (c) CMR QP/QS of 2.9 (pulmonary flow in green and aortic flow in pink). ASD: atrial septal defect; CMR: cardiac magnetic resonance imaging; QP: right ventricular stroke volume; QS: left ventricular stroke volume.
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CMR was pursued for it would be more likely to identify such lesions. The patient was also started on sildenafil citrate 20 mg three times daily followed by ambrisentan 5 mg daily for pulmonary hypertension, which resulted in significant improvement in symptoms. CMR findings were consistent with a large secundum ASD with a pulmonary flow to systemic flow ratio [right ventricular stroke volume/left ventricular stroke volume (QP/QS)] of 2.9 (Figure 1).
(a) TEE mid-esophageal four-chamber view confirming ASD with an adequate rim for percutaneous device closure (arrow). (b) Percutaneous deployment of a 26 mm Amplatzer Septal Occlusive device. ASD: atrial septal defect; TEE: transesophageal echocardiogram.
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ASD, the patient was evaluated for closure of the lesion (Figure 2).