Haemodynamic challenge in non-restrictive atrial septal defect.

A 55-year-old hypertensive man presented with history of New York Heart Association class II exertional dyspnoea for 3 years. The arterial pulse was normal. His blood pressure was 180/100 mm Hg. Jugular venous waveforms revealed prominent ‘a waves’ at the root of neck though the mean pressure appeared to be normal. A wide fixed split second heart sound and mid-systolic murmur at the pulmonary area were noted. A soft third heart sound and flow murmur at the left lower sternal border suggested significant pre-tricuspid left-to-right shunt. Echocardiography showed a 32 mm ostium secundum atrial septal defect (ASD) with deficient rims. Volume overload of the right atrium and right ventricle was noted. Left ventricular (LV) systolic function was normal with no regional wall motion abnormalities. Pulmonary venous return was normal. All cardiac valves were normal and competent. …