Simultaneous release of interdigitating atrial septal defect and patent foramen ovale Amplatzer devices

Abstract

In the absence of an alternative cause of breathlessness, a 73-year-old patient with an atrial septal defect and right volume overload on echocardiography was referred for transcatheter device closure under general anesthesia. After balloon sizing under fluoroscopy, a 22 mm Amplatzer (AGA Medical Corporation, USA) septal occluder device was partially deployed. However, transesophageal echocardiography revealed a large patent foramen ovale (PFO) (Figure 1A). Figure 1 Transesophageal, bicaval echo view of the interatrial septum. A Central ostium secundum atrial septal defect (ASD) and patent foramen ovale (PFO). B The ASD device is deployed but not released. The rim of the larger left atrial disc fails to cover neck ... Multiple defects in the atrial septum may be occluded by one large device (1), but the 22 mm device with a 7 mm left atrial disc rim failed to close the neck of the PFO (Figure 1B). Agitated saline contrast injection via the inferior vena cava revealed dense puffs of contrast moving across the PFO (Figure 1C). For dual ASD device closures, deployment of the smallest device followed by the larger is advocated (2). Our need for a large 34 mm Amplatzer PFO occluder posed a technical challenge, addressed in Figure 2. Figure 2 A Left atrial (LA) disc of atrial septal defect (ASD) device deployed with gentle traction into the defect within centre of fossa ovalis. The LA disc of the Amplatzer (AGA Medical Corporation, USA) patent foramen ovale (PFO) occluder overlapped the ASD ...