Closure of ASD and PDA Simultaneous in 24 month infant with PH and F/U 3 YEARS

Background: After birth, left atrial pressure rises, the flap valve of the foramen oval closes, and the septum premium and secundum then fuse to one another (in 80 to 85% of the population) to complete septation of the atrial chambers. The remaining 15 to 20%, however, have a persistent flap valve a patent foramen oval (PFO)†with the potential for ongoing or intermittent right-to-left flow Other failures in the normal development of the septum premium and septum secundum can result in true holes in the septal wall, known as atrial septal defects (ASDs).. These defects are named for their location in the septum and include septum premium ASDs at the crux of the heart, adjacent to the semilunar valves; secundum ASDs located centrally in the fossa oval; and sinus venosus ASDs, most commonly at the superior margin of the septum between superior vena cava and right pulmonary venous return . When an atrial septal defect (ASD) is present, there is left-to-right flow across the defect throughout the cardiac cycle. In diastole, the more compliant RV fills more easily than the stiffer LV, resulting in RV volume loading. This RV volume traverses the lungs, overloads the LA, and is the driving force of left-to-right shunting when the AV valves are closed. Because of the ability of the RV to maintain its systolic performance in a dilated state, children are virtually never symptomatic with atrial septal defects. This often results in increasing left-to-right shunt across the ASD, so that patients become symptomatic. Most infants with ASDs are asymptomatic. They may present at 6 to 8 weeks of age with a soft systolic ejection murmur and possibly a fixed and widely split S2. Rarely, ASDs in infants are associated with poor growth, recurrent lower respiratory tract infection, and heart failure.Case Presentation; The Patient is a24 month old boy with Down syndrome and has A history of recurrent hospitalization, Frequent hospitalization was due to pneumonia. No proper weighing in physical exam: A boy 2. Years old with Down syndrome, 9 kg weight, Systolic Murmur was heard at LSB. In Echo , Right Heart enlargement , TR ; 60 mmHg , RA Enlargement , ASD Secondum with 13 mmHg size , PA dilate , with some times PDA flow . Angiography was done due to further examine and, if possible close the ASD and PDA. PAP was 65 mmHg and High wedge pressure. I have to make sure there is no PPH. with complete caution and echo during the procedure, I closed the ASD. because I did not want to enter the right, decided to closure of the PDA with COIL Through the Retrograde .both ASD AND PDA have been successfully closed .During the three—year period, the patient’s growth was improved and he did not have frequent infections . Conclusion: some times, if the ASD is large and comes with another shunt like PDA, it can cause frequent infection, FTT, heart failure and retirement in the hospital. Particularly in Down syndrome, which usually has a systemic immune deficiency. with the timely treatment Of many of these complication is prevented.