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

Figure 4

(a) Transthoracic echocardiorgraghy (TTE) imaging in subcostal view demonstrates a large secundum ASD with a totally absent inferior rim. (b) TEE imaging in long axis bicaval view demonstrates large secundum ASD. (c) TTE imaging in subcostal view demonstrates the inflated Z-med balloon with the created inferior rim (arrows). (d) TEE in modified oblique plane demonstrates the inflated balloon at the entrance of IVC with created inferior rim. (e) TTE imaging in the subcostal bicaval view demonstrates the inflated balloon with a created inferior rim. (f) TTE imaging in subcostal bicaval view shows the mounted uncovered CP stent at the entrance of the IVC before the inflation. (g) TTE imaging in subcostal bicaval view demonstrates the inflated uncovered CP stent at the entrance of the IVC with the created inferior rim. (h, i) TEE imaging in a modified long axis view (angle 67°) demonstrates the created inferior rim (upper arrow) by tight inflation of an uncovered CP stent at the entrance of the IVC (lower arrow). (j, k) TTE imaging in subcostal long axis view demonstrates the atrial septal occluder in proper position capturing the created inferior rim (red arrow). (l) TEE imaging in long axis bicaval view demonstrates the proper position of the atrial septal occluder capturing the new inferior rim (upper arrow) which has been created by inflation of uncovered CP stent (lower arrow) at the entrance of IVC.

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