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Preoperative Visualization of an Atrial Septal Defect by 64-Slice Cardiac Computed Tomography

A 55-year-old woman with no prior cardiac history was referred for echocardiography after a precordial murmur was discovered on routine physical examination. Transthoracic and later transesophageal (Figure ​(Figure11) echocardiography revealed a secundum-type atrial septal defect (ASD) measuring 1 cm in diameter and mild mitral regurgitation with normal ejection fraction and no wall motion abnormalities. Because of her low risk for coronary disease, a cardiac computed tomography (CT) scan was done both to localize the ASD and to confirm the lack of significant coronary atherosclerosis (Figure ​(Figure22). 
 
 
 
Figure 1 
 
Transesophageal echocardiography demonstrating a large atrial septal defect. (a) Doppler interrogation demonstrates left atrium (LA) to right atrium flow of blood (arrow). (b) The atrial septal defect measured approximately 0.9 × 1.2 cm and was ... 
 
 
 
 
 
Figure 2 
 
Cardiac computed tomography demonstrating (a) no coronary anomalies and (b) no significant soft or calcified plaque in the coronary lumen. (c) There was confirmation of an enlarged right ventricle (RV), as seen in the axial images of the heart. (d) Navigator ... 
 
 
 
Intraoperatively, the secundum-type ASD was confirmed and repaired with no intraoperative or postoperative complications. She was discharged on hospital day 5 in good condition. 
 
We and others have previously described the utilization of 64-slice cardiac CT to effectively rule out coronary disease in low-probability patients scheduled for cardiac operations, including removal of an intracardiac tumor, closure of a ventricular septal defect, and valve repair or replacement (1–4). Additionally, CT has been described as a helpful adjunctive imaging test to evaluate the size and location of an ASD as well as in evaluating the impact of the ASD on right atrial and right ventricular chamber size (5, 6). 
 
This case is another example of the utility of 64-slice coronary CT to rule out significant coronary disease in a low-risk individual scheduled for cardiac surgery, sparing them additional preoperative invasive procedures.