Atrial septal defect associated with dilated cardiomyopathy in the setting of acute cardiac failure: importance of comprehensive bedside echocardiography in ICU.
The current report describes two patients with severe heart failure due to dilated cardiomyopathy in whom discrepancy between thermodilution cardiac output and clinical status was due to left-to-right shunt. Misdiagnosis of shunting was harmful in the early management of the first case. Secundum type atrial septal defect was confirmed by pathology in both cases. Blood samples for oxymetry should be routinely drawn during right heart catheterization for screening for intracardiac shunts. Using bedside echocardiography pulmonary-to-systemic flow ratio should also be systematically evaluated in the setting of right ventricular dilation.
Ennezat
Pierre Vladimir
PV
Centre Hospitalier Régional et Universitaire de Lille, Cardiology Hospital, Intensive care unit, Bd Pr J Leclercq, 59037 Lille Cedex, France. ennezat@yahoo.com
Juthier
Francis
F
Maréchaux
Sylvestre
S
Mouquet
Frédéric
F
Bauchart
Jean Jacques
JJ
Auffray
Jean Luc
JL
Montaigne
David
D
Asseman
Philippe
P
Vincentelli
André
A
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male