PFO or ASD

[cardio53]

My step son was assessed (2009) following a popliteal DVT. He underwent a cardiac echo which suggested a PFO which at subsequent TOE was rated as a 0.32-0.5cm PFO with aneurysmal interatrial septum and ortherwise normal right heart dimensions and function. At this time he was on Warfarin/Coumadin which was ceased at 6 months and left on Aspirin.
He subsequently (2010) developed angina and was diagnosed on CTCA to have an anomalous RCA arising from the LCA and passing between PA and AO and referred for surgical correction.
Follow up TEE showed normal right heart dimensions.
At surgery for the RCA, on opening the chest he was found to have right heart enlargement - on opening the right atrium he was found to have a ?? 3cm "hole" which as patched.
RCA correction was uneventful. He is currently home in recovery.
Q1. Are we seeing progression of a PFO? OR
Q2. Was an ASD missed?

[kenkeith]

ASD is a congenital anomaly and it may or may not include PFO.  ASD is a defect of the wall that separates the left and right upper chambers (septum) and  PFO is hole in the atrium that should have closed normally, and the location is the atrial septum. And the presentation would be part of the ASD anomaly with a small hole, enlarged hole and/or an aneursym.

QUOTE: Did they get it wrong at diagnostic?

>>>>>May not have considered it medically significant.

QUOTE:"Did the PFO prgress to ASD?"  

>>>>>>No!

QUOTE:Or did he have an ASD all along and it was miss diagnosed?

>>>>...don't know if missed or considered medically insignificant.  
Sometime ASD is obscured from a thoracic (chest) view.  A TEE could/would view the septum from a different angle and can confirm the diagnosis and provide a better evaluation in conjuction with a thoracic echo.

[cardio53]

My question remains
He was diagnosed with a 0.32cm PFO at echo and TOE two years ago - considered inconsequential to close.
BUT
At surgery he was found to have a 3cm+ ASD
Did they get it wrong at diagnostic?
Did the PFO prgress to ASD?
Or did he have an ASD all along and it was miss diagnosed?
Or did he have an ASD all along and the exam was inappropriately done?

[kenkeith]

What has been successfully treated is the congenital coronary anomaly where the right coronary artery's course is between the pulmonary artery and the aorta, The condition relates to the configuration of the right coronary artery.

PFO and ASD is a congenital defect that relates to a structual abnormality of the heart wall. The atrial septal (wall separating right and left atrium..upper chambers)  defect usually involves PFO (hole in the septum) that enables blood flow between the left and right atria via the interatrial septum. It usually is a left to right shunt (passing blood) from the left atrium through a hole into the right atrium rather than pumped into circulation.  

Hope this provides a perspective, and thanks for sharing.  If you have any further questions or comments you are welcome to respond.  Take care,

Ken