Simultaneous transcatheter management of incidental critical left main coronary artery disease in a young woman undergoing atrial septal defect device closure

AI Summary

Incidental critical left main coronary artery stenosis detected during transcatheter closure of large secundum ASD in an asymptomatic 28-year-old woman.
Intravascular ultrasound confirmed severe luminal compromise and guided successful left main stenting, followed by device-assisted ASD closure during the same procedure.
Illustrates potential for occult prognostically significant coronary disease in young adults and supports selective, individualised coronary evaluation, especially with family history of sudden cardiac death.

AI Summary

However, coronary imaging is selectively performed during ASD intervention to delineate anomalous coronary anatomy at risk of device-related compression, and emerging evidence indicates that clinically significant coronary artery disease may occasionally coexist silently in younger adults.

We report the case of a 28-year-old asymptomatic woman undergoing transcatheter closure of a large secundum ASD with deficient rims, in whom coronary angiography performed during invasive catheterization unexpectedly revealed critical left main coronary artery stenosis.

This case illustrates the potential for occult yet prognostically significant coronary artery disease in young adults undergoing congenital heart interventions and supports a selective, individualized, and context-driven approach to coronary evaluation, consistent with contemporary adult congenital heart disease guidelines.

Basic summary

Ann Pediatr Cardiol. 2026 Jul-Aug;19(4):437-442. doi: 10.4103/apc.apc_186_26. Epub 2026 Jul 31.

ABSTRACT

Transcatheter device closure is the preferred treatment for secundum atrial septal defect (ASD) in young adults with suitable anatomy. In this population, routine coronary angiography is generally not recommended in the absence of ischemic symptoms or conventional cardiovascular risk factors. However, coronary imaging is selectively performed during ASD intervention to delineate anomalous coronary anatomy at risk of device-related compression, and emerging evidence indicates that clinically significant coronary artery disease may occasionally coexist silently in younger adults. We report the case of a 28-year-old asymptomatic woman undergoing transcatheter closure of a large secundum ASD with deficient rims, in whom coronary angiography performed during invasive catheterization unexpectedly revealed critical left main coronary artery stenosis. Intravascular ultrasound (IVUS) confirmed severe luminal compromise, and successful IVUS-guided left main coronary stenting was performed, followed by device-assisted ASD closure in the same procedural session. Retrospective clinical assessment revealed a history of premature sudden cardiac death in a first-degree relative. This case illustrates the potential for occult yet prognostically significant coronary artery disease in young adults undergoing congenital heart interventions and supports a selective, individualized, and context-driven approach to coronary evaluation, consistent with contemporary adult congenital heart disease guidelines.

PMID:42602774 | PMC:PMC13475835 | DOI:10.4103/apc.apc_186_26

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