Skip to main content Skip to main navigation menu Skip to site footer

A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report


Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases and often diagnosed in adulthood. ASD represents a spectrum of disease with symptoms that vary from asymptomatic to right-sided cardiac volume overload, pulmonary arterial hypertension and atrial arrhythmias depending on the size of the defect, size of the shunt and associated anomalies. We reported a patient with large ostium primum ASD who underwent surgical closure with a pericardial patch.

Case Description: A 18 years old man came with chief complaint of abnormal ECG results of the screening examination of police candidates from Bhayangkara Hospital Manado. The patient had no complaints during admission. The patient could still carry out daily activities without any obstacles. The patient also could do high intensity sport without complaints of shortness of breath, heavy chest, or headaches. .Electrocardiogram (ECG) examination showed sinus rhythm, heart rate 74 beats per minute, left anterior fascicular block (LAFB), complete right bundle branch block (RBBB) and fragmented QRS at inferior leads. Transthoracic and transesophageal echocardiography revealed large ostium primum ASD L-R shunt.  Open heart ASD surgical closure with pericardial patch was done with good results and no residual shunt.

Conclusion: Large ostium primum ASD are associated with significant systemic-to-pulmonary shunts that results in desaturation requiring surgical closure. Large shunt of ASD patients who have a dilated right heart are associated with increased age-related morbidity and mortality. ASD with right heart dilatation should be considered for closure once the diagnosis is established regardless of the patient's age.


  1. Isselbacher KJ, Braunwald E, Wilson JD. Atrial septal defect. In: Isselbacher KJ, ed. Harrison's Principles of Internal Medicine. 13th ed. New York, NY: McGraw-Hill; 1994. 1041.
  2. Constantinescu T, Magda SL, Niculescu R, et al. New echocardiographic techniques in pulmonary arterial hypertension vs. right heart catheterization - a pilot study. Maedica Buchar. 2013 Jun. 8(2):116-23.
  3. Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 2008 Dec 2. 118(23):2395-451.
  4. Celermajer DS. Atrial septal defects: even simple congenital heart diseases can be complicated. Eur Heart J. 2018 Mar 21;39(12):999-1001.
  5. Menillo AM, Lee LS, Pearson-Shaver AL. Atrial Septal Defect. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from:
  6. Aoki H, Horie M. Electrical disorders in atrial septal defect: genetics and heritability. J Thorac Dis. 2018 Sep;10(Suppl 24):S2848-S2853.
  7. Torres AJ. Hemodynamic assessment of atrial septal defects. J Thorac Dis. 2018 Sep;10(Suppl 24):S2882-S2889.
  8. Baumgartner H, Backer JD, Babu-Narayan SV, Budts W, Chessa M, Diller GP, et al. 2020 ESC Guidelines for the management of adult congenital heart disease. European Heart Journal (2021) 42, 563-645.
  9. Kloesel B, DiNardo JA, Body SC. Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists. Anesth Analg. 2016 Sep;123(3):551-69.
  10. Naqvi N, McCarthy KP, Ho SY. Anatomy of the atrial septum and interatrial communications. J Thorac Dis. 2018 Sep;10(Suppl 24):S2837-S2847.
  11. Martin SS, Shapiro EP, Mukherjee M. Atrial septal defects - clinical manifestations, echo assessment, and intervention. Clin Med Insights Cardiol. 2014;8(Suppl 1):93-8
  12. Krasuski RA, Majdalany DS. Congenital Heart Disease in the Adult. In: Griffin BP, Kapadia SR, Rimmerman CM, editors. The Cleveland Clinic Cardiology Board Review Second Edition. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 264-266.
  13. Yang MC, Wu JR. Recent review of transcatheter closure of atrial septal defect. Kaohsiung J Med Sci. 2018 Jul;34(7):363-369.
  14. Webb G, Gatzoulis MA. Atrial Septal Defects in the Adult Recent Progress and Overview. Circulation. 2006;114:1645-1653.

How to Cite

Rampengan, S. H., & Rosmaningtyas, C. A. A. (2023). A patient with large ostium primum atrial septal defect who underwent open heart surgical closure with pericardial patch: a case report. Bali Medical Journal, 12(2), 1934–1939.




Search Panel

Starry Homenta Rampengan
Google Scholar
BMJ Journal

Christina Ayu Ariani Rosmaningtyas
Google Scholar
BMJ Journal