ABSTRACT
On May 27, 2022, the Asia Pacific Heart Rhythm Society and the Heart Rhythm Society convened a meeting of leaders from different professional societies of healthcare providers committed to arrhythmia care from the Asia Pacific region. The overriding goals of the meeting were to discuss clinical and health policy issues that face each country for providing care for patients with electrophysiologic issues, share experiences and best practices, and discuss potential future solutions. Participants were asked to address a series of questions in preparation for the meeting. The format of the meeting was a series of individual country reports presented by the leaders from each of the professional societies followed by open discussion. The recorded presentations from the Asia Summit can be accessed at https://www.heartrhythm365.org/URL/asiasummit-22. Three major themes arose from the discussion. First, the major clinical problems faced by different countries vary. Although atrial fibrillation is common throughout the region, the most important issues also include more general issues such as hypertension, rheumatic heart disease, tobacco abuse, and management of potentially life-threatening problems such as sudden cardiac arrest or profound bradycardia. Second, there is significant variability in the access to advanced arrhythmia care throughout the region due to differences in workforce availability, resources, drug availability, and national health policies. Third, collaboration in the area already occurs between individual countries, but no systematic regional method for working together is present.
ABSTRACT
We report the case of a 28-year-old woman with ostium secundum atrial septal defect, mitral stenosis and a persistent left superior vena cava, who developed heart failure at age 17 and was admitted at different institutions for shortness of breath. The patient had one complicated pregnancy at age 25 in which she presented with worsening heart failure. She was able to deliver her baby via spontaneous vaginal delivery under epidural anesthesia, but had to stay admitted for an additional 3 weeks. Two-dimensional echocardiogram with doppler studies showed an ostium secundum atrial septal defect, severe rheumatic mitral stenosis (Mitral Valve Area = 0.60 cm2 by planimetry and 0.90 cm2 by pressure half-time), severe tricuspid regurgitation, mild aortic regurgitation, pulmonary regurgitation with severe pulmonary hypertension, and a dilated coronary sinus. During bubble contrast study, micro-bubbles from the agitated saline appeared initially in the coronary sinus before appearing in the right sided chambers, suggesting the presence of a persistent left superior vena cava. Cardiac magnetic resonance imaging confirmed the initial echocardiographic findings. Cardiac catheterization and venography confirmed the presence of a persistent left superior vena cava which was draining into a markedly dilated coronary sinus, a severe mitral stenosis (MVA=0.86 cm2), an atrial septal defect with a left-to-right shunt (Qp:Qs = 2:1), and severe pulmonary hypertension. The combination of an atrial septal defect and mitral stenosis is rare, with an incidence ranging from 0.6 to 4% among those with congenital disease. The incidence of the combination of the three lesions - ASD, mitral stenosis and persistent left superior vena cava - is unknown. Since the pulmonary vascular disease was still reversible based on the hemodynamic studies, the plan was to have the patient undergo mitral valve replacement, tricuspid valve annuloplasty, and patch closure of the atrial septal defect. Before any surgical procedure could be done however, the patient succumbed to heart failure.
