# Multimodal Management of Complex Congenital Heart Disease: A Case of Atrial and Ventricular Septal Defects With a Bifid Apex

## TL;DR

A patient with complex heart defects was successfully treated using a combination of surgery and minimally invasive techniques, emphasizing the need for comprehensive care.

## Contribution

This case highlights a multimodal treatment approach for complex CHD involving ASD, VSD, and a bifid apex.

## Key findings

- Combined surgical and transcatheter closure successfully reduced shunting and right ventricular pressure.
- Residual mitral valve issues persisted, requiring continued monitoring.
- Bifid apex necessitated specialized imaging and management strategies.

## Abstract

Congenital heart disease (CHD) is one of the most common congenital anomalies influenced by both genetic and environmental factors. Atrial septal defect (ASD) and ventricular septal defect (VSD) are among the most common types of CHD. ASD is more common in females and often remains asymptomatic during childhood, leading to delayed diagnosis. Both surgical and percutaneous closure techniques are used, with evidence supporting early intervention for improved outcomes.

This study presents the case of a female patient with CHD, including ASD, VSD, and a bifid left ventricular apex, who was treated with both surgical and percutaneous approaches. The patient underwent open heart surgery for ASD closure at the age of 17 years. Eight years later, residual ASD and VSD were identified, and percutaneous transcatheter closure was performed using closure devices. Post-procedural imaging confirmed successful defect closure, a significant reduction in left-to-right shunting, and a decrease in right ventricular pressure. However, residual mitral valve prolapse and moderate mitral regurgitation persisted, requiring ongoing monitoring.

The presence of a bifid apex in this patient adds a unique anatomic consideration to managing CHD. While typically considered a benign variant, its association with other structural abnormalities requires careful evaluation. Future management strategies should include detailed imaging studies, such as cardiac MRI, to assess long-term ventricular function and detect potential complications. This case highlights the importance of a comprehensive, multimodal management strategy that includes surgical and transcatheter techniques for complex coronary artery disease cases. Regular follow-up with echocardiography and cardiac MRI is essential to monitor residual defects, assess ventricular function, and ensure long-term treatment success. Early detection and timely intervention are critical to optimizing patient outcomes, preventing complications, and improving quality of life.