MEDizzy - A 62-year-old man is being evaluated for mitral valve

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Disorders of the cardiovascular system 2

A 62-year-old man is being evaluated for mitral valve replacement surgery for severe mitral regurgitation. As part of his evaluation, he undergoes a transesophageal echocardiogram that demonstrates a small jet of right-to-left Doppler flow during systole across the atrial septum. The jet is located roughly in the middle of the septum and occurs when a small flap of tissue swings open <1 mm. There is no diastolic f ow, nor is there a visible opening in any part of the septum during diastole. Which of the following explains the finding on echocardiography?

ExplanationAtrial septal defect (ASD) is a common cardiac anomaly that may be first encountered in the adult and occurs more frequently in females. Sinus venosus ASD occurs high in the atrial septum near the entry of the superior vena cava into the right atrium and is associated frequently with anomalous pulmonary venous connection from the right lung to the superior vena cava or right atrium. Ostium primum ASDs lie adjacent to the atrioventricular valves, either of which may be deformed and regurgitant. Ostium primum ASDs are common in Down syndrome, often as part of complex atrioventricular septal defects with a common atrioventricular valve and a posterior defect of the basal portion of the interventricular septum. The most common ostium secundum ASD involves the fossa ovalis and is mid-septal in location; this should not be confused with a patent foramen ovale (which is present in ~25% of healthy adults). Anatomic obliteration of the foramen ovale ordinarily follows its functional closure soon after birth, but residual “probe patency” is a common normal variant; ASD denotes a true deficiency of the atrial septum and implies functional and anatomic patency.