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

Figure 3

(a) Transthoracic echocardiogram, subcostal bicaval view demonstrates a large secundum ASD with an absent inferior rim. (b) TEE in long axis bicaval view shows large secundum ASD with absent inferior rim with right sided volume overload. (c, d) TEE in long axis view demonstrates the struts of the distal part of the inflated CP stent (yellow arrow) at the entrance of the IVC creating a new inferior rim (red arrow). (e) TEE imaging in a modified long axis view demonstrates struts of the inflated uncovered CP stent (yellow arrow) at the entrance of the IVC creating a new inferior rim (red arrow) which has been captured by two discs of the ASO (white arrow). (f) Cine angiogram of the IVC in frontal view demonstrates the uncovered CP stent mounted over the Z-med balloon size (25 × 40 mm) at the entrance of the IVC under the guidance of the TEE for proper position of the stent. (g) Cine imaging of the heart in four chamber view demonstrates the inflation of the uncovered CP stent, 8 zig, 45 mm, using Z-med balloon size (25 × 40 mm) at the entrance of the IVC into the RA under the guidance of the TEE. (h) Cine imaging of the heart in frontal view demonstrates the inflation of the second CP-stent 8 zig, 39 mm, overlapping with previous stent for proper fixation. (i) Cine imaging of the heart in the frontal projection demonstrates the proper deployment of the Amplatzer septal occluder size 34 mm before release. (j) RA angiogram in four chamber view through cook sheath 14F demonstrates the deployed septal occluder which was well aligned with IAS. (k) Cine imaging of the heart in aneteroposterior projection demonstrates both the two overlapping uncovered CP stents in the IVC with the proper position of the atrial septal occluder. (l) Cine imaging of the heart in four chamber projection demonstrates two overlapping uncovered CP-stents and the device which is well aligned with IAS under the guidance of the TEE, the device is not anchored the CP stent at all.

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