Residual right to left shunt leading to cyanosis for thirty years following surgical closure of atrial septal defect

Atrial septal defect (ASD) closure may be complicated with residual right to left shunt leading to cyanosis. In this case, the patient was operated for low venosus type ASD 30 years ago. He suffered from exertional dyspnea and cyanosis (oxygen saturation: 85%) for years and he still did not accept any reintervention. The probable mechanisms for the residual shunt are ineffective suture placement at the ostium of inferior venae cavae or a tear in the patch after surgical procedure.