Case report Combined percutaneous treatment of atrial septal defect and pulmonic or aortic stenosis in adult patients Pavol Tomasov, Katerina Linhartova, Petra Antonova, Radka Adlova, David Alan, Josef Veselka Cardiology Department, Cardiovascular Center, University Hospital Motol, Prague, Czech Republic Submitted: 14 August 2010 Accepted: 20 October 2010 Arch Med Sci 2010; 6, 6: 976-980 DOI: 10.5114/aoms.2010.19312 Copyright © 2010 Termedia & Banach A b s t r a c t Combined atrial septal defect and pulmonic or aortic stenosis are relatively uncommon conditions in adult patients, with few reported cases of percutaneous treatment. We present two patients with secundum type atrial septal defect and concomitant pulmonic or aortic stenosis and their treatment by transcatheter techniques. Key words: heart septal defects, septal occluder device, balloon valvuloplasty Introduction Secundum type atrial septal defect (ASD) combined with pulmonic or aortic stenosis is a relatively uncommon condition in adult patients. Percutaneous closure of ASD in indicated patients is a legitimate alternative to surgical treatment. Percutaneous balloon valvuloplasty for pulmonic stenosis, described in 1982 [1], is a procedure of choice for both adolescent and adult patients (class I recommendation according to the ACC/AHA guidelines [2]). There are several reports of patients being treated by a percutaneous technique, either staged or combined, with no clear agreement as to which procedure should be performed first [3-4]. Percutaneous balloon valvuloplasty for calcific aortic stenosis might be considered as a palliative treatment for patients eligible for neither a surgical approach nor transcatheter aortic valve implantation (TAVI) [2]. There is a report of a combined percutaneous ASD closure and double balloon valvotomies for mitral and aortic stenosis in a patient with Lutembacher’s syndrome [5]. Case report Patient 1 A 63-year-old woman underwent a transthoracic and transoesophageal echocardiogram due to dyspnoea on exertion (NYHA class II). She was diagnosed with a large secundum type atrial septal defect (19 mm in diameter, Figure 1) with left-to-right shunt and pulmonic stenosis (maximal pressure gradient 49 mmHg). The patient was referred for percutaneous closure of the ASD and pulmonic balloon valvuloplasty. Coronary angiography with normal findings was performed via the right femoral artery. Right heart catheterization was performed via the right Corresponding author: Pavol Tomasov, MD Cardiology Department Cardiovascular Center University Hospital Motol V uvalu 84 Prague, 150 06, Czech Republic Phone: +420 224 434 901 Fax: +420 224 434 920 E-mail: p.tomasov@seznam.cz