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Cardiovascular Images

Cough

A Potentially Life-Threatening Condition After Interventional Closure of Atrial Septal Defect

Stephan Schoof, MD; Kambiz Norozi, MD, PhD, FRCPC; Thomas Breymann, MD; Armin Wessel, MD, PhD and Harald Bertram, MD

From the Department of Pediatric Cardiology and Intensive Care Medicine (S.S., K.N., A.W., H.B.) and the Division of Thoracic and Cardiovascular Surgery (T.B.), Medical School Hanover, Hanover, Germany; and the Division of Paediatric Cardiology (K.N.), Department of Paediatrics, University of Western Ontario, London, Ontario, Canada.

Correspondence to Kambiz Norozi, MD, Medical School Hannover, OE 6730, Carl-Neuberg-Str 1, 30623 Hannover, Germany. E-mail norozi.kambiz@mh-hannover.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 3.5-year-old girl (weight, 19 kg; height, 103 cm) was hospitalized for interventional closure of secundum atrial septal defect (ASD II). In transthoracic and transesophageal echocardiography (TEE), we found a hemodynamically relevant left-to-right shunt caused by isolated ASD II without any systemic or pulmonary venous anomaly. All heart valves were patent and showed no regurgitation. The size of the ASD II was 9.5x7 mm, with enough rims to the aorta, the superior wall of the atrium, and the systemic and pulmonary veins (Figure 1A). No balloon sizing was performed.

View larger version (61K):   Figure 1. TEE shows ASD with left-to-right shunt (A). TEE of Amplatzer septal occluder shows its accurate position without any shunt (B). Fluoroscopy (C: frontal; D: lateral) shows that the device is correctly positioned after deployment.

 
With the patient under general anesthesia, a 10-mm Amplatzer Septal Occluder (ASO; AGA Medical, Golden Valley, Minn) was implanted with no complications. The postinterventional TEE, in all standard positions, showed no relevant shunt and accurate positioning of the ASO (Figure 1B and online-only Data Supplement), which also was documented by fluoroscopy (Figure 1C and 1D).

In the recovery room and later in the ward, the patient began to cough repeatedly, so she was given isotonic saline solution and corticosteroid to inhale. She was hemodynamically stable the entire time.

A routine transthoracic echocardiography performed the next day showed absence of the ASO in situ (atrial septum), with the ASO imaged in the region behind the left atrium (. . . [Full Text of this Article]