Chandigarh, July 20: A rare case of atrial septal defect (ASD) closure surgery was performed on a 67-year-old female patient at IVY Hospital, Mohali recently thus making her the second elderly person in the world to undergo this procedure.
Atrial septal defect, a hole in the upper chambers of the heart, is the most common congenital heart disease seen in adults. While it is recommended to close this defect during childhood, symptoms typically emerge in the second decade of life.
The surgery was successfully conducted by a team of doctors, including Dr. Virender Sarwal, director of cardiothoracic and vascular surgery (CTVS), Dr. Vikram Arora, head of cardiac anesthesiology and Dr. Abhinav Nayyar, consultant CTVS.
In 1974, at the age of 18, the patient was diagnosed with this congenital heart condition. However, due to family circumstances and an early marriage, she could not undergo surgery at that time.
For the past 49 years, she has lived with the condition, raising her family. Recently, she came to the hospital for knee replacement surgery, presenting with class II breathlessness. Upon examination, an atrial septal defect was discovered.
The surgery was performed with the assistance of a heart-lung machine, and the hole was closed using a chemically treated pericardial patch, which mimics the heart's natural covering. The patient recovered well and was discharged on the third day after the operation. During the first follow-up appointment, she appeared happy and had made a good recovery. Her X-ray showed regression of heart enlargement.
This case represents the second oldest female to undergo ASD closure at the age of 67. The general advice is to undergo surgery as soon as the defect is diagnosed to prevent its adverse effects on the lung vasculature, advised Dr. Sarwal.
Meanwhile ASD occur in approximately 6.4 per 10,000 births and have a female to male ratio of 2:1, making them the second most common congenital heart disease after ventricular septal defect (VSD).
Left untreated, this condition can result in a shunting of blood from the left side of the heart to the right side, ultimately leading to flooding of the lungs and increased pulmonary artery pressures, informed Dr. Sarwal.
If left chronically, it may also lead to a dangerous reversal of the shunt. Therefore, early closure of the defect is recommended, as modern surgery carries low mortality rates and offers improved functional capacity, Dr Sarwal maintained.
However, closing an ASD in elderly patients is not without challenges. They may experience irregular heart rates and acute left heart failure, as sudden closure increases the load on the left ventricle, he pointed out.
To address these issues, a flap valve technique was utilized during the surgery, providing relief in the immediate post-operative period and helping satisfy the patient's concerns, he said.
The closure of ASD in elderly patients is becoming more common, with numerous case reports documenting successful surgeries in individuals aged 60 and above, with the oldest patient being 70 years old. In this specific case, the patient had an enlarged heart shadow with prominent pulmonary arteries.
An ECG revealed axis deviation, and an echocardiogram showed a 2.9 cm ASD with high pulmonary artery pressure. Further investigation through a coronary angiogram indicated normal coronary arteries, except for sluggish blood flow. Prior to undergoing knee replacement surgery, the patient was advised to undergo heart surgery to ensure her safety. Favorably, she had not experienced a reversal of the shunt, making her condition operable, and she did not have any other comorbidities.
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