J Cardiovasc Ultrasound.  2014 Dec;22(4):220-223. 10.4250/jcu.2014.22.4.220.

Atrial Septal Defect with Normal Pulmonary Arterial Pressure in Adult Cyanotic Patient

• Kim IC
• Kim H
• Lee JE
• Yoon HJ
• Kim JB
• Kim JH

• KMID: 1980427
• DOI: http://doi.org/10.4250/jcu.2014.22.4.220

Abstract

A 22-year-old male presented with recurrent stroke, central cyanosis, and dyspnea. Transesophageal echocardiography and cardiac catheterization revealed bidirectional shunt flow through atrial septal defect (ASD) without pulmonary arterial hypertension. The orifice of inferior vena cava facing towards ASD opening led partially right to left shunt resulting in cyanosis with normal pulmonary arterial pressure.

Keyword

Atrial septal defect; Cyanosis; Inferior vena cava

MeSH Terms

Adult*
Arterial Pressure*
Cardiac Catheterization
Cardiac Catheters
Cyanosis
Dyspnea
Echocardiography, Transesophageal
Heart Septal Defects, Atrial*
Humans
Hypertension
Male
Stroke
Vena Cava, Inferior
Young Adult

Figure

• 

  Fig. 1 Clubbing finger of the patient (absence of normal diamond shaped Schamroth's window between two opposite nailbeds, which indicates positive Schamroth's test).

• 

  Fig. 2 Initial chest X-ray (A) and transthoracic echocardiography of parasternal long axis (B) and apical 4-chamber view (C). These tests showed that cardiac chambers were not enlarged and left ventricular ejection fraction was normal.

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  Fig. 3 Transthoracic echocardiography with agitated saline bubble test in modified apical 4-chamber view. Filling of LV cavity with bubble starts at the same time when RV cavity is filled (A and B), LV fulfillment is finished within 4 beats immediately after appearance of RV bubble (C and D). Arrow indicates each cardiac cycle of the image. RV: right ventricle, LV: left ventricle, RA: right atrium, LA: left atrium.

• 

  Fig. 4 Transesophageal echocardiography with color Doppler imaging during early systole (A) and mid-diastole (B).

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  Fig. 5 Sagittal view of heart dynamic computed tomography reveals that inferior vena cava flow (arrow) drains partially towards left atrium via atrial septal defect (asterisk). IVC: inferior vena cava, LA: left atrium, RA: right atrium, SVC: superior vena cava.

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