# Atrial septal defect becoming clinically evident after cardiac surgery for annuloaortic ectasia: a case report

## TL;DR

A previously undiagnosed heart defect was discovered after a patient's surgery for a different heart condition.

## Contribution

Highlights how an undiagnosed atrial septal defect can become evident after cardiac surgery.

## Key findings

- Right ventricular volume overload was identified as a key indicator of an undiagnosed atrial septal defect.
- Computed tomography failed to detect the defect before surgery, but it was later diagnosed via echocardiography.
- Monitoring pulmonary artery dilatation over time helped in diagnosing the defect.

## Abstract

Right ventricular volume overload is the key finding in a patient with previously undiagnosed atrial septal defect (ASD).

A 68-year-old female was referred to our hospital due to progressive pulmonary artery dilatation observed on her chest X-ray. Echocardiography revealed a secundum ASD with right ventricular dilatation. She had undergone aortic root replacement and aortic valve replacement for annuloaortic ectasia and aortic insufficiency 12 years prior to the diagnosis. She was also diagnosed with Marfan syndrome, which was supported by family histories. Computed tomography did not show a secundum ASD before the surgery. We finally closed the secundum ASD with catheter closure device.

Ascending aneurysm might mask the presence of secundum ASD. Monitoring the change in pulmonary artery dilatation overtime is useful for the diagnosing secundum ASD.