A 10 year boy w as brought to us in Aug 2003 w ith c/o mild exertional dyspnoea since
childhood. There w as an h/o recurrent respiratory tract infections in childhood, w ith
failure to thrive and a small delay in developmental milestones. No h/o cyanosis. On
examination, he had RV type of apex, left parasternal heave, w ide, fixed splitting of S2,
ESM in pulmonary area, and a Mid-diastolic murmur in tricuspid area. He w as clinically
diagnosed to have ASD. 2D Echo revealed a large ostium secondum type of ASD w ith
LR shunt, w ith e/o Right sided volume overload and mild pulmonary hypertension. The
defect size w as 18-20 mm and there was a good rim of tissue all around the defect.
In addition, there w as mild thickening of mitral valve near the tips (? myxomatous,?
rheumatic) but no significant diastolic gradient. The patient was subjected to ASD device
closure using Amplatz device. The patient w as fine for following two years w ith
remarkable improvement in symptoms. Subsequently, he was lost to follow-up.
Since last tw o years he again started having progressive effort dyspnoea, initially NY HA
class II but w hich gradually progressed over next several months to NYHA class III. He
came to us for the follow up in October 2007
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