Atrial Septal Defect Closure Research Articles

Thoracoscopic closure of atrial septal defect in perfused beating hearts.

This study aims to characterize the mid and long-term clinical outcomes of 856 atrial septal defect cases that underwent closure using MTCST without the assistance of a robotic system. From June 2009 to September 2023, a total of 856 cases at our center underwent selective repair of a secundum-type atrial septal defect using MTCST without Da Vinci robotic assistance. According to whether the operation was performed during an arrested heart or not, patients were divided into arrested heart group (n = 110) and beating heart group (n = 746). Cardiopulmonary bypass was established peripherally. Three-port incisions in the right chest were conducted first, followed by a pericardiotomy, superior and inferior vena cava snaring, atriotomy, and the closure of atrial septal defect under a thoracoscope. Patients were followed up from 3 months to 12 years postoperatively. The exclusively MTCST for atrial septal defect closure was successfully performed without any in-hospital mortality in both groups. None of the procedures required an alternative technique for the closure. There were significant learning curves for cardiopulmonary bypass time and operation time. No residual shunt was observed in all patients during the follow-up transthoracic echocardiography at 5-day and 3-month timepoints postoperatively. This study demonstrates that an exclusively MTCST for atrial septal defect repair is safe, simple, and minimally invasive. Exclusively MTCST is a new desirable alternative beside robotic-assisted atrial septal defect repair.

Robot-Assisted Atrial Septal Defect Closure Via the Left Atrium: Dual Case Reports.

Robot-Assisted Atrial Septal Defect Closure Via the Left Atrium: Dual Case Reports.

Echocardiographic Screening Model for Improved Assessment of Atrial Septal Defect Closure: A Multicenter Retrospective Study.

Atrial septal defect (ASD) is a prevalent congenital heart condition in adults, which finally leads to pulmonary hypertension and right heart failure if left untreated. Right heart catheterization (RHC), the current gold standard for determining ASD closure feasibility, is invasive. Thus, a noninvasive prescreening tool is urgently needed. In a multicenter, retrospective study, we assessed 924 ASD patients (2012-2022) to determine their suitability for ASD closure. Using LASSO regression, we identified predictors for a correctable shunt, enabling us to create the ASD model. The ASD model, comprising of estimated pulmonary artery systolic pressure (ePASP), peak velocity through the pulmonary valve (PV), peak E-wave velocity through the tricuspid valve (TVE), and right atrial longitudinal dimension (RA) by echocardiography, was constructed and exhibited favorable discriminative capability with an area under the curve (AUC) of 0.941 (95% CI: 0.920-0.961) in the derivation group. The model also demonstrated good calibration and discriminative abilities in the validation cohort. When juxtaposed with the earlier congenital heart disease (CHD) model, the newly developed ASD model demonstrated superior predictive capabilities for correctable shunt, supported by the net reclassification index (NRI) [0.063 (95% CI: 0.001-0.127, p = 0.047)] and integrated discrimination improvement (IDI) [0.023 (95% CI: 0.011-0.036, p <0.001)]. In summary, our research advocates the ASD model as a superior tool for screening suitable ASD defect closure candidates.

Long-term heart failure risk after atrial septal defect closure in elderly

Abstract Background There is concern that atrial septal defect (ASD) closure will unmask underlying diastolic dysfunction or left heart disease in elderly causing heart failure. It is controversial whether fenestrated devices should be used in elderly patients. Purpose To assess the long-term heart failure risk after ASD closure in elderly and risk factors associated with heart failure hospitalization in a single centre. Method From 2003-2023, all elderly patients aged more that 60 years old who had ASD closure performed successfully in this centre were retrospectively studied. Baseline demographics, underlying risk factors and survival without heart failure hospitalization were analyzed. Result From 2003-2023, 73 patients aged more than 60 years old underwent successful ASD closure in our centre. None of these patients had balloon occlusion test for assessment of left atrial pressure. Median age was 66 years old (60-84) at operation and 27 (37.0%) of them were male. Common risk factors included diabetes (n=9, 12.3%), hypertension (n=31, 42.5%) and ischaemic heart disease (n=8, 11%). Thirty-nine (53.4%) patients had pre-existing atrial fibrillation and 17 (23.3%) of them had moderate to severe left sided valvular lesions. Heart failure symptoms were present in 31 (42.5%) of them (Figure 1). During a median follow-up time of 4 years (1-15 years), 80.8% of patients did not experience heart failure hospitalization (Figure 2). Pre-existing atrial fibrillation and left-sided valvular lesions were associated with higher risk of heart failure hospitalization (OR 4.06, 95% CI 1.03-16.06 p=0.036 and OR 4.9, 95% CI 1.41-17.09 p=0.009). Conclusion In a median follow-up time of 4 years, patients aged more than 60 years old had low rate of heart failure hospitalization after ASD closure. Pre-existing atrial fibrillation and left-sided moderate to severe valvular lesions were associated with higher risk of heart failure admission. Further studies should be conducted on ASD closure in these group of patients.Figure 1Figure 2

Sex differences in outcomes among patients undergoing transcatheter atrial septal defect closure: Do they benefit equally?

Abstract Background Although sex differences in congenital heart disease are prevalent and relevant, there is limited research on their role in atrial septal defect (ASD) closure. We aimed to investigate sex differences in baseline characteristics, procedural and long-term outcomes of patients with transcatheter ASD closure. Methods Data from adult patients undergoing ASD closure between 2005-2016 were retrospectively analyzed. Results Of the 853 patients included, 281 (32.9%) were male and 572 (67.1%) were female. Females were more symptomatic at presentation than males (p &amp;lt; 0.001). Males had a higher frequency of cardiovascular comorbidities than females (p &amp;lt; 0.001). Although echocardiographic right ventricular (RV) diameter relative to body surface area was equal in males and females (2.49 cm/m2 versus 2.57 cm/m2; p = 0.072), males had more RV dysfunction (12.1% versus 7.6%; p = 0.028). In contrast, females had higher RV systolic pressures (39.71 mmHg versus 37.23 mmHg; p = 0.025), and were more likely to have moderate to severe tricuspid regurgitation (15.4% versus 8.9%; p = 0.007). Males had larger defects with use of larger implants (p &amp;lt; 0.05). Procedure-related complications were rare and did not differ by sex. At 12-month follow-up, both male and females showed comparable decreases in RV diameter (-0.57 cm versus -0.59 cm; p = 0.751), RV systolic pressure (-4.57 mmHg versus -6.31 mmHg; p = 0.094), and severity of tricuspid regurgitation (p = 0.173; Figure). After a mean follow-up of 3 years (SD = 5), no significant differences were observed in the incidence of death (incidence rate ratio (IRR) = 0.49 [95% CI 0.27-0.83]; p = 0.402), new onset atrial fibrillation (IRR = 3.22 [95% CI 2.57-3.99]; 0.063), cardioversion or ablation (IRR = 0.40 [95% CI 0.20-0.71], p = 0.335), stroke/TIA (IRR = 0.29 [95% CI 0.12-0.56]; p = 0.745), and pacemaker implantation (IRR = 0.29 [95% CI 0.12-0.57], p = 0.728). Conclusions Although patient profiles differed by sex, procedural and long-term outcomes were comparable, suggesting that transcatheter ASD closure can be safely performed in both males and females.Figure.Sankey Plot

4-year follow-up results of percutaneous closure of atrial septal defect with the total biodegradable poly-L-lactic acid device: date from a prospective, single-center trial

Abstract Background The poly-L-lactic acid (PLLA) device is a novel, total biodegradable occluder dedicated to percutaneous closure of atrial septal defect (ASD) .Closure of ASD with the PLLA device has proven to be relatively safe and effective in our preclinical and first-in-human studies. Objective The aim of the study was to evaluate long-term safety and efficacy of the PLLA device in percutaneous closure of ASD in a large cohort of patients. Methods A prospective study enrolling patients who had a clinically significant ASD was conducted in our institution from May 2018 to August 2019. Percutaneous ASD closure was undertaken with the PLLA device. Evaluations were scheduled pre-hospital discharge and again at 1, 3, 6, 12, 24, 36 and 48 months post implantation. Primary endpoints were a composite of clinical success, including closure success and no major complications at the 48-month follow-up evaluation. Results A total of 52 patients (35 children, 55.8% females, median age 7.55 years, median weight 28.75Kg) underwent an attempt at percutaneous ASD closure with PLLA device. Successful device implantation was achieved in 50 (96.1%) of 52 patients with delivery attempts. All the 50 patients (100%) completed 4-year follow-up visit. Closure success at 4-year follow-up were 84% (42/50), with 8 patient (16%) reported to have clinically significant leaks, including 2 large residual leaks, 5 moderate residual leaks, and 1 small residual leak. 10 complications occurred, with 1 event of cardiac arrhythmia during procedure, and 9 follow-up events, consisting in cardiac arrhythmias (n=6), moderate or large mitral regurgitation (n=2), and headache (n=1). Conclusion Percutaneous ASD closure with PLLA device in human seems to be safe. However, increased occurrence of residual leaks overtime indicated that long-term efficacy of PLLA device in human was sub-optimal.TTE follow-up of a case with PLLA device

Transcatheter closure of atrial septal defect (ASD) in adult and paediatric population without transoesophageal echocardiography/general anaesthesia

Abstract Background Transcatheter device closure is the preferred therapeutic option for ostium secundum atrial septal defect(OS-ASD). Standard practice is to perform it under transoesophageal echocardiography(TEE) guidance. However, TEE is performed under general anaesthesia (GA) and leads to increases in cost, procedural duration, ICU stay, total hospital stays, risk of oesophageal injury and complications of GA. Transthoracic echocardiography(TTE) is an excellent alternative and prior studies have shown it to be a safe alternative in paediatric population. In current study we analysed safety and efficacy of TTE-guided device closure of OS-ASD in all comer population irrespective of age, weight, defect size. Methods The study enrolled all patients who underwent device closure of OS-ASD between March 2017 and December 2023. All procedures were performed under LA for adults and conscious sedation for children. The device was placed under fluoroscopy guidance and position were confirmed on TTE. Procedural success, device, defect size ratio, procedural time, fluoroscopy time, complications, intensive care unit/hospital stay duration were analysed and compared with our own experience of 125 patients with TEE-guided closures before switching to complete TTE-guided procedure(before 2017). Results 340 patients underwent TTE-guided device closure of ASD. Procedure success was 97.4% with acceptable risk of major complications. Three(0.8%) had embolization into pulmonary artery, successfully operated surgically. Two had tamponade requiring drainage. In 9 patients, device could not be deployed despite multiple attempts and approaches. All of these had defect size of &amp;gt; 34mm and deficient IVC rim along with shorter (other than aortic) rim. Findings were compared with our own previous experience of TOE guided closure (practised before 2017). Compared to TOE group, TTE group had significantly lower total procedural duration (75±4 vs. 28 ±1 min; p &amp;lt; 0.01), intensive care unit stay (24±10 vs. 10.5±1 h; p &amp;lt; 0.01), and hospital (48±12 vs. 25.5±4h; p &amp;lt; 0.01) stay duration. Fluoroscopic time was similar in both. There was no mortality in either group. Major complications were comparable, TTE-guided group had less post-procedure complications of vomiting and headache. Additional findings of less pre-procedure fasting duration and early commencement of post procedure oral intake were noted in TTE group. Conclusion TTE-guided device closure of OS-ASD is a safe and feasible in all-comer population in experienced hands. It can definitely negate the use of TEE except in very poor echo window. The added advantages include utilization of physiological variations in PV/LV pressure during cough, Valsalva manoeuvres in awake patients. It definitely reduces the procedural duration, cost of procedure and dependence on GA and trained transoesophageal echocardiographer.

Air embolism during unsuccessful transcatheter closure of secundum atrial septal defect in a patient with an undetected left-sided inferior vena cava.

A 46-year-old man with a history of secundum atrial septal defect and interstitial lung disease was admitted to the hospital for a planned transcatheter closure of the atrial septal defect. Following multiple failed attempts to place a right femoral vein catheter, the procedure was aborted. Another attempt was made to the left femoral vein, but that attempt was complicated by an unfamiliar resistance. Even though resistance was met during insertion, the catheter was further inserted until a position in the inferior vena cava above the liver was obtained at fluoroscopy. Simultaneously, the patient became unresponsive. The procedure was immediately aborted and the atrial septal defect closure was not completed. Air embolism to the heart and brain was detected using echocardiography and computed tomography. The patient died 15 days after the procedure. Death was attributed to severe cerebral edema due to air embolism. The autopsy revealed a left-sided inferior vena cava. This case report demonstrates that unexpected congenital vascular anomalies complicating a routine transcatheter closure of the atrial septal defect can result in a fatal outcome.

Cardiac arrest in pregnancy with successful stabilization and delivery on veno-arterial extracorporeal membrane oxygenation: a case report

Abstract Background Cardiac arrest in pregnancy is rare. Clinicians need to adapt management to the altered anatomy and physiology of pregnancy, and the well-being of two patients (mother and foetus) may come into consideration. The medical literature has limited reports on outcomes following extracorporeal membrane oxygenation (ECMO) in pregnancy. Case summary We report the evaluation, management, and outcome of a woman with cardiac arrest and severe left ventricle (LV) dysfunction in mid-trimester of pregnancy. The previously well woman had tolerated two prior term pregnancies without complication. At 25 weeks of gestation, she presented to the hospital with breathlessness and vomiting after a pre-syncopal episode at home. She then had in-hospital cardiac arrest, managed initially with cardiopulmonary resuscitation. The LV was dilated, thin walled, and severely impaired (LV ejection fraction 14%), and there was a secundum atrial septal defect (ASD). She was supported with veno-arterial ECMO. Planned birth occurred 5 days post-arrest for maternal indication. Coronary angiography demonstrated 99% proximal left anterior descending artery stenosis and aneurysm, raising the possibility of previous subclinical Kawasaki disease. She underwent surgical revascularization and ASD closure. Both mother and infant made a good recovery. Discussion We report a case of cardiac arrest in pregnancy as first presentation of severe LV dysfunction. The case highlights the role of ECMO for cardiac arrest in pregnancy and outlines specific interventions and management concepts in this setting.

Safety and feasibility of transcatheter closure of atrial septal defects in small children weighing less than 10 kg.

When young patients with an oval fossa defect present early with symptoms of heart failure and pulmonary hypertension, surgical treatment is recommended in small bodyweight rather than transcatheter closure. Outcomes of device closure in consecutive symptomatic children weighing under 10 kg were compared with young children aged below 4 years but weighing above 10 kg. Transthoracic echocardiography under conscious sedation guided the procedure in all without need for balloon sizing, transesophageal echocardiogram, and intubation anaesthesia. Symptoms, anthropometry, shunt ratio, pulmonary pressures, defect and device size, percentage oversizing, device/body weight ratio, complications, and post-procedural growth spurt were compared. Ninety-six patients weighing under 10 kg were compared with 160 patients weighing above 10 kg. In total, 83.3% of patients in the study group and 25% of controls were severely malnourished. The median indexed defect size was 35.2 mm/sq.m and 27.4 mm/sq.m, and the device was oversized by 8.7% and 14.2% in the study group and controls, respectively. The device/body weight ratio was 1.93 in study group and 1.4 in controls. Procedure was successful in all except one patient weighing under 10 kg who had a device embolisation. Both groups showed significant growth spurts and proportion, with severe malnutrition reduced to 42% and 11% in the two groups. Device closure was feasible and safe in patients under 10 kg. Transthoracic echocardiographic imaging on conscious sedation provided adequate guidance. Symptoms and growth significantly improved after intervention. Despite a larger defect size, smaller patients had comparable outcomes. In symptomatic children under 10 kg needing early closure, transcatheter intervention should not be deferred.

A Report of Inadvertent Narrowing of Coronary Sinus Ostium During Surgical Closure of Ostium Secundum Atrial Septal Defect, Identified Perioperatively Using Transesophageal Echocardiography.

A Report of Inadvertent Narrowing of Coronary Sinus Ostium During Surgical Closure of Ostium Secundum Atrial Septal Defect, Identified Perioperatively Using Transesophageal Echocardiography.

Acute Limb Ischemia as a Complication of Early Infectious Endocarditis Following Surgical Closure of an Atrial Septal Defect: Case Analysis and Literature Review

Background: This study reports the case of a 47-year-old woman who presented with acute pain and coldness in the left lower limb, occurring 5 months after a surgical closure of an atrial septal defect (ASD). Initial examination suggested acute limb ischemia. Methods: Doppler ultrasound and computed tomography (CT) angiography of the lower extremity arteries confirmed the presence of an occlusion in the left popliteal artery. Echocardiography revealed vegetation on the surgical patch used for the ASD closure. Blood cultures were positive for Staphylococcus aureus. Treatment: The patient was treated with antibiotics for 6 weeks and underwent replacement of the surgical patch. Conclusion: This case underscores the importance of screening for endocarditis in patients with systemic embolism and a history of ASD patch closure, even though endocarditis is a rare complication. In cases of systemic emboli and large vegetations, a therapeutic approach often requires surgical removal and replacement of the closure patch.

Echocardiography-guided percutaneous closure of oval-shaped secundum atrial septal defects

BackgroundAn atrial septal defect (ASD) is considered oval-shaped when its shortest diameter is less than 75% of the longest diameter. Research on percutaneous closure of oval-shaped ASDs is limited, with no known reports of non-fluoroscopic closure for this population.ObjectiveTo assess the effectiveness of non-fluoroscopic percutaneous closure for oval-shaped ASDs.MethodsThis single-center retrospective study evaluates patients undergoing non-fluoroscopic percutaneous closure of oval-shaped ASDs, defined by the shortest to longest diameter ratio < 0.75, a circular index of 1.33, or ultrasound visualization of an oval shape. Device size was chosen to be 0–4 mm larger than the defect’s longest diameter, based on transthoracic and transesophageal ultrasound measurements.ResultsWe identified 78 patients (33.3% children, 20.5% males) with a mean age of 27.4 ± 16.3 years and a mean weight of 46.8 ± 19.8 kg. The mean longest diameter and mean shortest diameter of ASDs were 23.3 ± 6.8 mm and 15.8 ± 5 mm, respectively. The mean ratio of the shortest to longest diameter was 0.7 ± 0.1. Percutaneous closure was not attempted in 7/78 (9%) patients. Three out of 71 (4.2%) procedures were fluoroscopy-guided upfront due to technical difficulties, and 5/71 (7%) were converted to fluoroscopy-guided closure. Overall procedural success rate was 98.6% (70/71) including 63/71 (88.7%) performed with zero fluoroscopy. Mean device size was 26.5 ± 7.1 mm. Mean procedural time was 45.3 ± 22.6 min. Eleven intraprocedural complications occurred including 6 arrhythmias, 3 pericardial effusions, and 2 device dislodgements.ConclusionTranscatheter closure of oval-shaped ASD is safe and feasible. Echocardiography is adequate for adequate operative guidance.

Permanent pacemaker implantation after combined mitral- and tricuspid valve surgery: a nationwide multicentre study.

The threshold to perform concomitant tricuspid valve (TV) repair during primary mitral valve (MV) surgery has decreased, based on recent randomized evidence. Based on these developments, the indication for TV repair during MV surgery is expected to increase further. However, concerns have been raised regarding the risk of permanent pacemaker implantation (PPI) during a concomitant procedure. Therefore, we aim to assess the incidence of PPI in combined MV and TV surgery in a nationwide registry. The current study uniquely cross-linked the Cardiothoracic and Pacemaker/ICD registry of the Netherlands Heart Registration. Patients undergoing primary MV and TV surgery (± atrial septal defect closure, rhythm surgery, coronary artery bypass grafting) between 1 January and 31 December2021 were included. The primary outcome was PPI within 30 days after surgery. Subgroup analyses were performed for isolated MV and TV surgery and MV repair. The association between concomitant TV surgery and PPI was assessed using multivariable binary logistic regression analyses. A total of 1060 patients (n = 833 MV, n = 227 MV + TV) were included. The overall incidence of PPI was 4.3%. No significant difference in PPI between MV and MV + TV surgery were found (3.7% vs 6.6%, P = 0.06). Concomitant TV surgery was not an independent risk factor for PPI after surgery after adjustment for covariates. These results were robust after sensitivity analyses. The current study was not able to find a statistical difference between the PPI rate in MV surgery patients and MV + TV surgery patients. Extension of the waiting period prior to PPI, may result in decreased PPI rates.

Lateral atrial septal defect closure with induced ventricular fibrillation versus cardioplegic arrest.

We present our single-centre results of paediatric patients who underwent surgical atrial septal defect II closure via lateral thoracotomy. Retrospective analysis. Patients were divided into a cardiac arrest group and a cardiac fibrillation group. All procedures were performed via right midaxillary thoracotomy through a single incision without side ports. All 37 consecutive patients between March 2019 and August 2022 (median age 3 years; percentile 25th: 2; 75th: 5 years) in both groups were free of mortality and postoperative morbidity such as haemodynamically relevant residual shunt or malignant arrhythmias. Cardiopulmonary bypass time was significantly shorter in the fibrillation group (mean: 34.7 min vs 52.6 min, P = 0.01), and all patients were weaned off the ventilator immediately postoperatively. Length of the intensive care unit stay was not different between the 2 groups. Postoperative hospital stay was significantly longer in patients with cardiac arrest (mean: 5.6 days vs 4.9 days, P = 0.04). Postoperative laboratory parameters did not differ between the 2 groups. All patients were discharged with normal left ventricular function and normalized cardiac enzymes. Minimally invasive closure of an atrial septal defect during atrial fibrillation is a safe procedure with results comparable to those of an induced cardiac arrest procedure.

Ultrasound-Based Cardiac Output Monitoring During Pediatric Open-Heart Surgery in Children

Aim of the study. To evaluate the feasibility of using non-invasive hemodynamic monitoring technology based on Doppler ultrasound during open-heart surgery in children.Material and methods. Prospective, observational, single-center cohort study included 20 patients aged 10 to 34 months undergoing surgery for congenital heart defects. Ten patients underwent atrial septal defect closure (ASD group), other 10 patients had ventricular septal defect closure (VSD group). Cardiac output (CO) was measured in all patients to guide inotropic and infusion therapy adjustments at three control time points: (1) after intubation and before skin incision, (2) during the immediate post-bypass period with the chest open after weaning from cardiopulmonary bypass (CPB), and (3) after sternal closure and before transfer to the intensive care unit (ICU).Results. At time point 1, the CO values for both the ASD and VSD groups were within the normal reference range: 5.2 L/min [4.7; 5.5] and 5.1 L/min [4.6; 5.6], respectively. At time point 2, CO was measured in 15 of 20 patients, including 8 patients in the ASD group and 7 in the VSD group. Coverage was 75% because of the challenges of measuring 5 patients on the operating table. In the immediate post-bypass period, two patients with VSD (25%) developed hypotension with CO reduced to 3.6 L/min, which is lower than the age-related hemodynamic reference value (5.1 L/min). Inotropic support in these two patients was increased by switching from dopamine, 7 mcg/kg/min, to adrenaline at a dose of 0.05 mcg/kg/min, resulting in improvement of hemodynamic parameters and an increase in CO to 5.2 L/min and 5.0 L/min, respectively, compared to normal agerelated reference values (4.1; 6.1 L/min). After sternal closure, CO values in both groups did not differ significantly from age-related reference values.Conclusion. The USCOM cardiac output monitoring device can be used to manage intraoperative hemodynamics and adjust inotropic therapy even during open chest surgery. However, its routine use in all stages of surgery with median sternotomy is difficult because it requires more time to align the aortic valve projection.

A Comparative Study of Computed Tomography and Ultrasound Imaging on Device Size during Percutaneous Atrial Septal Defect Closure

A Comparative Study of Computed Tomography and Ultrasound Imaging on Device Size during Percutaneous Atrial Septal Defect Closure

Atrial Septal Defect

Background: Atrial Septal Defect (ASD) is one of the most common congenital heart diseases, occurring in about 25% of children and accounting for 6-10% of all congenital heart conditions. ASD is more frequently observed in females with a ratio of 2:1 and often does not show symptoms in infants, unless there is an increase in right ventricular volume. Case Report: A 7-year-old girl was referred with complaints of shortness of breath and cyanosis at the fingertips, accompanied by palpitations. Initial diagnosis was established through physical examination and echocardiography, which revealed a secundum ASD measuring 1.9 cm. The ASD closure surgery was performed but had to be halted due to intraoperative bradycardia. The patient then underwent subsequent therapy with Lisinopril and Spironolactone and was in good condition at the last follow-up. Discussion: Management of ASD, whether through surgical or catheter-based intervention, is recommended to prevent further complications such as paradoxical embolism and pulmonary hypertension. This case underscores the importance of timely diagnosis and treatment to prevent long-term health impacts in patients with ASD.

Perioperative Considerations for ASD Device Closure in the First Trimester: A Case of Secundum ASD with Bidirectional Shunt

Introduction: Atrial septal defect (ASD) closure during pregnancy is a complex procedure requiring careful consideration of maternal and fetal risks. This case report highlights the perioperative management of a secundum ASD with a bidirectional shunt in a patient during her first trimester. Case presentation: A 31-year-old woman, G3P2A0, presented at approximately 10-11 weeks gestation with a recently diagnosed large secundum ASD and pulmonary hypertension. She was on Sildenafil and Bisoprolol. Due to the potential risks associated with an unrepaired ASD during pregnancy, the decision was made to proceed with percutaneous ASD closure. General anesthesia was administered with meticulous hemodynamic monitoring. The procedure was successful, and the patient recovered without complications. Conclusion: ASD closure during the first trimester can be safely performed with careful planning and execution. Multidisciplinary collaboration and vigilant monitoring are crucial for optimal maternal and fetal outcomes.

A single centre retrospective study on balloon assisted technique in transcatheter closure of large atrial septal defects

A single centre retrospective study on balloon assisted technique in transcatheter closure of large atrial septal defects