Complications
Presents with chest pain or syncope after device closure.
Presents after repair of an interatrial communication with post-operative fever, chest or abdominal pain, vomiting, and fatigue.
Caused by embolism of a venous thrombus into the systemic arterial circulation through the interatrial communication. Requires the presence of a right-to-left shunt through the interatrial communication. A right-to-left shunt can occur intermittently in patients while coughing or during a Valsalva manoeuvre, or may be present at rest in patients with Eisenmenger's physiology. This complication is usually seen in adults with an undiagnosed interatrial communication. It may present as a stroke or transient ischaemic attack. Additionally, there can be peripheral emboli.
Usually does not occur until after the fifth decade of life. In adults, symptoms include fatigue, decreased exercise tolerance, dyspnoea on exertion, orthopnoea, paroxysmal nocturnal dyspnoea, and oedema.
Can also occur in infants with interatrial communications; the main presenting symptom in infants is tachypnoea.
Can occur as a complication of device closure or surgery. Antibiotic prophylaxis is recommended for the first 6 months after repair of an interatrial communication.[23][27] Patients with unrepaired cyanotic heart disease will also require endocarditis prophylaxis when undergoing certain interventions.
Often presents non-specifically, and most commonly involves fever with possible physical signs of peripheral emboli: Osler's nodes, Roth's spots, or Janeway's lesions. A cardiac murmur may sometimes be noted.
Echocardiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)/CT imaging are useful for diagnosis.[34]
Symptoms include rapid palpitations, dizziness, or shortness of breath. Occurs in large defects as a result of atrial enlargement and hypertrophy. Treatment of interatrial communications may help in controlling atrial arrhythmias; however, incidence of recurrent arrhythmias is higher with delayed closure of interatrial communications. Pregnancy can precipitate atrial fibrillation due to the increased volume load. The incidence of atrial arrhythmias increases with age, especially between the fifth and seventh decades of life.[8] Atrial arrhythmias should be treated to restore and maintain sinus rhythm if possible.[35]
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