Unusual Complication With Transcatheter Closure of an Atrial Septal Defect Prevented by Adequate Imaging

Abstract

A 44-year-old woman with progressive dyspnea was referred for transcatheter closure of a recently diagnosed secundum atrial septal defect (ASD). Chest x-ray showed prominent pulmonary arteries, a mild pulmonary volume overload, and a moderate right ventricular enlargement (Figure 1). ECG demonstrated normal sinus rhythm with mild repolarization disturbances in leads III and avL, an incomplete right bundle-branch block, and an indifferent axis with normal time intervals (Figure 2). Cardiac catheterization revealed a significant left-to-right shunt (Qp:Qs=2.9) and coronary angiography a type RII …