case_images: PMC9988386_01
case_images: (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.
case_images: CRIC2023-2393308.001.jpg
case_images: PMC9988386_01_CRIC2023-2393308.001.jpg
case_images: fig1
case_images: 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).
case_images: (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.
case_images: CRIC2023-2393308.002.jpg
case_images: PMC9988386_01_CRIC2023-2393308.002.jpg
case_images: fig2
case_images: ASD, the patient was evaluated for closure of the lesion (Figure 2).