Atrial septal defect repair gone wrong

Isolated atrial septal defect (ASD) accounts for 13% of congenital heart disorders. The anatomic location, size, and coexistence of other cardiac anomalies determine outcomes of repair. Surgical closure was the first-choice treatment until the 1990s and remains the only treatment for large defects. We describe a case of a 64-year-old woman who underwent surgical repair for an ASD as a child in 1959. She presented with dyspnea to the hospital almost 53 years after the surgery. Diagnostic cardiac imaging revealed interesting anatomy of the repair surgery. Transthoracic echocardiography showed areas of flow signal across the patch consistent with surgical perforation of the patch to reduce symptoms of superior vena cava (SVC) syndrome. Despite intervention, severe dilation of the SVC along with a thrombus is seen. CT angiography of the heart showed the ASD patch occluding the ostium of the SVC instead of patching the ASD. Transesophageal echocardiography showed malpositioned patch-allowing the sinus venosus ASD to remain patent.