Feasibility of Transcatheter Closure of Large Secundum Atrial Septal Defect with Absent Superior or Inferior Rim

Figure 1

(a) Two-dimensional transesophageal echocardiography (TEE) imaging in long-axis bicaval view demonstrates a large secundum ASD with an absent rim near the SVC. (b) TEE in long axis view reveals the struts of the CP stent (yellow arrow) with the atrial septal occluder (red arrow) anchoring on the newly created superior rim by tight inflation of the covered-CP stent. (c) Cine imaging of the heart in the frontal projection demonstrates the inflation of the modified covered CP-stent 8 zig, 45 mm length by Z-med balloon size 22 × 40 mm. (d) Cine imaging of the heart in the frontal projection shows the deployed ASO in proper position with the projected part of the modified CP-stent out of RA disc before release. (e) Selective PA angiogram in four chamber view (LAO 35, cranial 35) demonstrates complete closure of the defect with no residual shunt. (f) Cine imaging of the heart in frontal projection demonstrates the inflated Z-med balloon (25 × 40 mm) slipped down in front of the septal occluder which did not capture the projected part of the modified CP stent, this balloon dilatation have been done three years later to achieve adult size of SVC.

(a)

(b)

(c)

(d)

(e)

(f)