Atrial Septal Defect Occluder Research Articles

Occlusion of Iatrogenic Atrial Septal Defects After Mitral Valve-in-Valve Implantation With a Novel Bioresorbable Occlusion Device

Occlusion of Iatrogenic Atrial Septal Defects After Mitral Valve-in-Valve Implantation With a Novel Bioresorbable Occlusion Device

Unexpected Right Atrial Disk Expansion of Atrial Septal Defect Occluder: a rare complication of percutaneous occluder.

Unexpected Right Atrial Disk Expansion of Atrial Septal Defect Occluder: a rare complication of percutaneous occluder.

Managing a Challenge Case: Transesophageal Echocardiography-Guided Transcatheter Closure of a Large Secundum Atrial Septal Defect in a Pregnant Woman

Background: The management of complex cardiovascular conditions during pregnancy poses unique challenges, and in the case of a large secundum atrial septal defect (ASD), achieving successful closure through a transcatheter approach guided by transesophageal echocardiography (TEE) requires careful navigation and expertise. This study sought to present a case that exemplifies the contemporary approach of using TEE guidance for the closure of an ASD in pregnant women Case presentation: A 31-year-old woman with multigravida, diagnosed with secundum ASD and pulmonary hypertension, underwent TEE. The TEE examination revealed a significant ASD measuring 2.8-3.1 cm with inadequate surrounding rims. Subsequently, our intention was to employ a device to address this defect. TEE was utilized to guide the placement of a 14F delivery sheath into the left upper pulmonary vein and left atrium. Using a catheter, we successfully deployed a 40 mm ASD Occluder (MemoPart), concluding the intervention without any complications. Given the concerns regarding the potential risks of radiation exposure and teratogenic effects on fetal development, particularly in young patients and during pregnancy, it is crucial to prioritize TEE-guided closure of ASD for the safety of both the mother and the fetus. Conclusion: Closure of ASD with zero fluoroscopy proved to be a safe and effective procedure, demonstrating feasibility and significant benefits for pregnant women with ASD. Keyword: Atrial Septal Defect, Pregnant Woman, Transcatheter Closure, Transesophageal Echocardiography.

Shed Atrial Septal Occluder Removed by Gastric Biopsy Forceps: A Case Report

Atrial septal defect (ASD) is a common congenital heart disease, and can be treated with occluders. However, occluder detachment remains one of the most urgent complications to be resolved. This paper reported a case of ASD occluder detachment, which was successfully resolved with gastroscopic biopsy forceps. A 57-year-old woman complained chest distress for over one week, and was admitted to cardiovascular department of Sir Run Run Shaw Hospital. Based on echocardiography, the patient was diagnosed as ASD, mitral and tricuspid valve regurgitation. On the second day after percutaneous closure of residual ASD, routine chest radiographs showed the occluder detached into the abdominal aorta. After a thorough evaluation and examination, we decided to use gastric biopsy forceps to remove occluder. As a result, the patient recovered well and discharged from the hospital. For postoperative patients with ASD, when occlusion devices detached and conventional strategies could not extract the occluders, gastric biopsy forceps would be appliable. Compared to conventional strategies, gastric biopsy forceps have better grasping force, and provide secure fixing for disconnected or detached occlusion devices in cardiac interventional surgeries.

Right disc thrombosis of the new Gore Cardioform ASD Occluder.

The GCA is a well performing device in terms of efficacy despite complex anatomies (aortic rim <5 mm and ASD diameter >17 mm) with a good safety profile. To evaluate atrial septal defect (ASD) features impacting on right disc device thrombosis in patients who underwent Gore Cardioform ASD Occluder (GCA) implantation. A total of 44 consecutive patients undergoing percutaneous ASD with GCA device from January 2020 to September 2022 at our tertiary care Center were evaluated. The minimum follow-up was 6 months. The patients were stratified in two groups according to a cut-off value of ASD diameter equal to 20 mm at sizing balloon, derived from ROC analysis (AUC = 0.894; p = 0.024). Baseline characteristics were comparable between groups in terms of age, sex, weight, height, and interatrial septum dimensions. Patients with ASD > 20 mm (n = 9) had a higher ASD/device dimension ratio, both at echocardiography (p = 0.009) and at sizing balloon (p = 0.001), longer fluoroscopic time (p = 0.022), and higher incidence of device thrombosis (0.006). Right disc thrombosis was observed in three patients of the ASD > 20 mm group, always in the inferior portion of the right disc. On univariate analysis, ASD diameter at sizing balloon (OR 1.360; p = 0.036) was the only positive predictor of device thrombosis. Right disc thrombosis of the GCA device may be under-recognized at follow-up, hence deserving clinical attention, especially in those patients with larger ASD diameters.

Device-related thrombosis after transcatheter closure of atrial septal defect using the Gore Cardioform ASD occluder.

A previously healthy 60-year-old female was diagnosed with a secundum atrial septal defect measuring 23 x 12 mm on transesophageal echocardiogram.

Cerebral Embolism and MINOCA Secondary to Left Atrial Myxoma after Occlusion of Atrial Septal Defect by Amplatzer Occluder: A Case Report.

Primary heart tumors are rare, with atrial myxomas being the most common type. Atrial myxomas can lead to embolisms, heart obstruction, and systemic symptoms. Herein, we report a case of 72-year-old woman who presented with a left atrial myxoma at the atrial septal defect occluder, a new acute cerebral infarction, and MINOCA (myocardial infarction with no obstructive coronary atherosclerosis). Left atrial myxoma is a common primary cardiac tumor; however, left atrial myxomas arising after percutaneous atrial septal defect occlusion are rare. Additionally, the patient presented with a new case of multiple systemic emboli. The patient underwent surgical resection of a left atrial myxoma, occluder, and left atrium, and atrial septal repair, and was discharged with good recovery for outpatient follow-up. The possibility of a cardiac tumor, especially an atrial myxoma, which can lead to a series of complications, should be considered at the closure site after percutaneous atrial septal closure. Therefore, active surgical treatment and long-term follow-up are warranted in such cases.

The Importance of Weight-Based Protocols and Reduction of Frame Rates in ASD Percutaneous Closure

Introduction: In the context of interventional and diagnostic cardiology procedures, there is a growing effort to minimize exposure to ionizing radiation. Most modern angiography machines allow selection of exposure parameters based on the patient's weight. Our experience has led us to question whether the use of weight-based protocols is the right approach for pediatric interventional cardiology exams. Aim and Materials: The purpose of this research is to investigate the efficacy of techniques aimed at reducing radiation exposure during ASD percutaneous closure in pediatric patients. Since 2020, in all patients we used predefined acquisition parameters with a low exposure level (CARD &lt;6Kg) and reduced pulsations to 4p/s. Therefore, from 2020 we used the lowest possible radiological pediatric protocol regardless of patient weight. We compared this group of patients (B) with an historical group of patients (A) with an ASD, in which a radiological protocol based only on patient’s weight was applied. Results: Group A included 92 patients with ostium secundum atrial septal defect. Group B included 114 patients with ostium secundum atrial septal defect. In this group, 22 patients received a Gore Cardioform ASD occluder device with the need of a biplane imaging. The two groups were comparable in terms of age (p=0.1) and weight (p=0.2). The absorbed dose in group A was significantly higher than in group B. Median total air kerma was 6.55 mGy(1.2-255,6 mGy) in group A and 5.25 mGy(0.4-140.5 mGy) in group B (p 0.001). Dose area product (DAP) was 130,2 μGym²(24.25-5774 μGym²) in group A and 67.1 μGym²(8.6-3107 μGym²) in group B(p 0.001). Conclusion: Our strategy resulted in a significant reduction in radiation exposure to the patients while maintaining good radioscopic resolution. This significance was maintained despite the use of new devices in 2021 in addition to Amplatzer (GORE-Occlutech).

Infective Endocarditis After Percutaneous Device Closure of Atrial Septal Defects: Incidence, Diagnosis, and Treatment. Case Report and Literature Review.

Infective endocarditis (IE) on atrial septal defect (ASD) closure devices, while extremely rare, has been reported to be more frequent early after the procedure. We describe a case of late IE after percutaneous closure of patent foramen ovale (PFO). We also performed a literature review on this subject. We reviewed a total of 42,365 patients who were treated with percutaneous devices: 13,916 for ostium secundum (OS) (32%), 24,726 for PFO (58%) and 3,723 for OS+PFO (8%). Among these patients, we identified 50 cases of IE after atrial septal defect device closure (0.001%). In contrast to previous reports, nearly 66% of IE in this setting occurred late, after at least 6 months from the procedure (33/50 patients). A statistical analysis clearly showed that the mean time from the procedure to IE increased in the last five years, probably associated with a change in antiplatelet therapy after ASD closure. Management of IE on an ASD occluder should always be discussed in the setting of a multidisciplinary heart team that includes a cardiologist, cardiac surgeon, and anesthetist. While surgical strategies gave excellent results, conservative management might be considered in cases of small IE vegetations and for patients in good general condition. However, in these cases, the patient must be closely observed with repeated blood and instrumental tests.

Atrial septal defect occluder devices and embolization – a case series

Introduction: Atrial Septal Defect (ASD) secundum is a commonly occurring congenital heart disease. Patients with unstable hemodynamic may require closure, which can be accomplished either percutaneous transcatheter of an atrial septal occluder (ASO) device or open surgery. Closure using an occluder carries the risk of device embolization (DE). Case Presentation: This case series presents two patients who had dislodgement after ASD closure using ASO. The demographic data, comorbidities, surgical details, and follow-up results are all summarized. A 9-year-old girl and a 12-year-old boy admitted to our centre. The girl echocardiography evaluation revealed dislodgment of ASD occluder in a large secundum ASD, right upper PV blockage, and a high chance of pulmonary hypertension (PH). While the boy showed the occluder device that was misplaced and positioned in the right ventricle. A secundum ASD with a left to right shunt and moderate TR with a peak pressure gradient of 21.5mmHg were also found. During the procedure, we discovered that the girl had an occluder in the superior rim of ASD II 3x2 cm, which was dislodged towards the lower right PV, above the mitral valve, and the posterior occluder leaflet was removed by replacing a section of the rim. We discovered a secundum ASD with a dimension of 2x1cm on the boy The occluder was found behind the anterior cusp of the tricuspid valve. The retrieved occluder device appeared intact, and the tricuspid valve was injured, but no rupture. Conclusion: The occurrence of ASO migration is uncommon, necessitating further surgery for device removal, closure of the remaining defect, and ensure there is no cardiac erosion or rupture. Surgery can also alleviate symptoms including shortness of breath and palpitations

Atrial septal defect occluder combined with stent graft for the management of post-dissection aortic aneurysm previously treated with unsuccessful coils: a case report

BackgroundAlthough the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders.Case presentationWe present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up.ConclusionsOur case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.

Impact of Gore Cardioform Atrial Septal Defect Occluder on Atrial and Ventricular Electromechanics in a Pediatric Population

Transcatheter closure is the first-line treatment for ostium secundum atrial septal defect (ASD). The GORE Cardioform ASD Occluder (GCA) is potentially innovative compared with other self-centering devices. This study aimed to compare the mechanic changes in atrial and ventricular properties before and after GCA implantation. All consecutive patients aged <18years who underwent isolated ASD closure with a single GCA device were enrolled from 2 centers. Echocardiography and electrocardiogram were performed the day before, 24hours, and 6months after ASD closure. Between January 2020 and February 2021, 70 pediatric patients with ASD were enrolled. The mean age was 7.9 ± 3.9years, and the mean defect diameter was 17.1 ± 4.5mm. Global longitudinal strain analysis showed no change in left ventricular longitudinal function (T0 -23.2 ± 2.8%, 24 hours -23.0 ± 2.8%, and 6months -23.5 ± 2.7%). An early and transient reduction in longitudinal strain was detected in the basal septal segments (T0 -19.8 ± 3.3%, 24 hours -18.7 ± 3.6%, and 6months -19.2 ± 3.4%), left atrium (T0 41.4 ± 15.3%, 29.2 ± 1.4%, and 39.0 ± 12.9%), and right ventricle (-27.6 ± 5.4%, -23.6 ± 5.0%, and -27.3 ± 4.6) 24hours after closure, secondary to hemodynamic changes because of flow redirection after ASD closure. Six months after the procedure, only the left atrium showed a mild global longitudinal strain reduction because of the presence of the device within the septum. GCA device had no impact on global and regional ventricular function. Atrial mechanics were preserved, except for the segments covered by the device. This is the first device demonstrating no impact on the left and right ventricular mechanics, irrespective of the device size.

Abstract 15989: Gore Cardioform Device Complicated by Delayed Right Atrial Disk Expansion

This is a 31-year-old male with a recently discovered secundum atrial septal defect (ASD) with significant left-to-right shunt and associated right ventricular enlargement and dysfunction underwent an uncomplicated percutaneous ASD closure device placement earlier in 2023. Five weeks later, upon repeat transthoracic echocardiogram (TTE), the patient was found to have new onset atrial flutter and what was thought to be a large device-related thrombus abutting the right atrial disc. The patient was admitted to the hospital, started on systemic anticoagulation, and AV nodal blocker therapy. X-rays and a transesophageal echocardiogram (TEE) were performed and showed a Gore Cardioform ASD occluder device that was complicated with significant expansion of the right atrial disk and loosening of fabric likely in the setting of displacement of locking pin (Figure 1A-B). No clear thrombus was visualized. The patient underwent an uncomplicated ASD closure device removal, ASD repair with pericardial patch, right sided Maze, and left atrial appendage ligation in May of 2023 (Figure 1C). We report a case of extreme expansion of the right atrial disk of the Gore Cardioform septal occlusion device. Very few cases of right or left atrial disk expansion have been reported but only in the immediate post-implantation period. This is thought to be secondary to immediate post-operative increase in left atrial pressures. In our patient, intra-procedural TEE and immediate post-procedural TTE the day after showed a well-apposed device across the ASD with no residual shunt. Furthermore, the wedge pressure measured during the procedure was within normal limits. Extreme expansion of the right atrial disk five weeks after the implantation has not been reported. While we know that the pin unlocking caused the expansion of the atrial disk, it is currently unclear as to what initiated this series of events.

Single tertiary center experience using Gore Cardioform Atrial Septal Defect Occluder for secundum atrial septal defect closure with a focus on deficient rims.

The data on the use of Gore Cardioform Septal Occluder (GCA; W. L. Gore and Associates, Inc.) for atrial septal defect (ASD) with deficient rims is limited. All patients evaluated by transesophageal echocardiogram (TEE) for ASD occlusion were included. TEE planes at 35°, 0°, and 90° were assessed for anterior-superior (AS) and posterior (P), anterior-inferior (AI) and posterior-superior (PS), as well as superior (S) and inferior (I) rims. ASD size >20 mm, and rims less than 5 mm were defined as large and deficient, respectively. We included patients who had a procedural failure along with the patients in whom the procedure was not attempted after echocardiogram in the unsuccessful group. In 148 patients, the median weight, age, and ASD size were 36 kg (range, 8-60 kg), 11.8 years (range, 1-60 years), and 14.2 ± 8.28 mm, respectively. One or more deficient rims were noted in 112 of 148 (75.7%): 99 (67%) AS, 36 (24%) P, 17 (11%) AI, 30 (20%) PS, 26 (18%) S, and 33 (22%) I. ASD closure was performed in 115 (78%) patients. The procedure was successful in 111 (96.5%) patients with procedural failure in 4 (3.4%) patients. Multiple deficient rims were associated with reduced procedural success (OR 0.36, 95% CI, 0.25-0.56). On multivariate analysis deficient P, PS, and I rims were associated with an unsuccessful group (P = .001, .046, and .005, respectively). Complications included 1 device embolization, 1 vascular injury, and 5 arrhythmias. Transcatheter closure of ASDs with deficient rims is feasible using GCA. Large ASDs with deficient P, PS, and I rims were associated with unsuccessful closure. Risk stratification and comprehensive evaluation of ASD rims is vital for the use of GCA.

Assessment of degradability and endothelialization of modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluders over time in vivo

ObjectiveTo evaluate the fiber-degradation and endothelialization of a modified poly L-lactic acid (PLLA) atrial septal defect (ASD) occluder for a long time in vivo.MethodsA total of 57 New Zealand rabbits were selected to establish the vasculature implantation model, which would be used to characterize the mechanical properties and pathological reaction of PLLA filaments (a raw polymer of ASD occluder). In total, 27 Experimental piglets were used to create the ASD model for the catheter implantation of PLLA ASD occluders. Then, X-ray imaging, transthoracic echocardiography, histopathology, and scanning electron microscope (SEM) were performed in the experimental animals at 3, 6, 12, and 24 months after implantation.ResultsIn the rabbit models, the fibrocystic grade was 0 and the inflammatory response was grade 2 at 6 months after vasculature implantation of the PLLA filaments. The mass loss of PLLA filaments increased appreciably with the increasing duration of implantation, but their mechanical strength was decreased without broken. In the porcine models, the cardiac gross anatomy showed that all PLLA ASD occluders were stable in the interatrial septum without any vegetation or thrombus formation. At 24 months, the occluders had been embedded into endogenous host tissue nearly. Pathological observations suggested that the occluders degraded gradually without complications at different periods. SEM showed that the occluders were endothelialized completely and essentially became an integral part of the body over time.ConclusionIn the animal model, the modified PLLA ASD occluders exhibited good degradability and endothelialization in this long-term follow-up study.

Transcatheter closure of postsurgical aortic pseudoaneurysms guided by three-dimensional image reconstruction: asingle-centre experience.

Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are apotentially lethal complication after cardiac or aortic surgery. Surgical management can pose achallenge with high in-hospital mortality rates. Transcatheter closure is aless-invasive alternative treatment option for selected patients, although current experience is limited. We aimed to evaluate procedural and imaging outcomes of our first 11cases of transcatheter PTAP closure with the use of closure devices. Patients with ahigh operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion. Eleven consecutive patients with ahigh operative risk and ahistory of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of asupracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular PlugIII (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%. Although subtotal or total occlusion of the PTAP was found at follow-up in only 45-73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer avaluable minimally invasive primary treatment option for patients who otherwise would face ahigh-risk reoperation.

Early embolization of atrial septal defect occluder device into the left atrium

Atrial septal defect (ASD) is one of the most common types of congenital heart defects. Percutaneous closure of ASD is relatively safe and accepted as an alternative to surgery. However, device-related complications can occur rarely. Embolization of the Amplatzer atrial septal occluder (ASO) is one major complication of percutaneous device closure. The author presents a case of early embolization of ASO device into the left atrium, which removed the device surgically, and the ASD was closed.

P113 TRANSCATHETER CORRECTION OF RESIDUAL INFERIOR SINUS VENOSUS DEFECT AFTER SURGICAL CLOSURE

Abstract A 21–year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV–ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event. The contrast transcranial Doppler (CTD) was positive for right–to–left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left–to–right shunt and severe RLS after Valsalva’s Manovre (&amp;gt;20 bubbles) (fig.A–B). No clear intra–cardiac source of embolization was detected on workup. After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior–posterior rim towards the IVC (&amp;lt;5 mm). A Figulla Flex II ASD Occluder with the smallest waist of 4 mm was implanted with no evidence of residual intraprocedural shunt; no intraprocedural complications were observed (fig.C). The 1 month follow–up CTD was negative for RLS. Conclusions Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior–inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case–by–case basis. Reference 1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure. Cardiovascular Intervention and Therapeutics (2021) 36:256–259 2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002

PO-04-028 INTERATRIAL SHUNT LEADING TO SEVERE HYPOXEMIA: A RARE COMPLICATION OF PACEMAKER-ASSOCIATED INFECTIVE ENDOCARDITIS

Pacemaker-lead-associated infective endocarditis is a serious complication with high morbidity and mortality. We present a case of persistent hypoxemia from significant right to left atrial shunting across the patent foramen ovale (PFO) as a result of pacemaker-lead-associated infective endocarditis with large vegetations. N/A A 56-year-old female with stroke, sleep apnea, diabetes mellitus, hypertension, and sick sinus syndrome with dual chamber pacemaker implantation, was admitted with acute hypoxic respiratory failure requiring high flow nasal cannula. A chest x-ray did not show any obvious etiology of hypoxemic respiratory failure. Arterial blood gas showed no hypercapnia ruling out hypoventilation as the cause of hypoxemia. A very high A-a gradient was noted, raising suspicion for shunting. Blood cultures were positive for staphylococcus capitis bacteremia. A transesophageal echocardiogram (TEE) showed several large vegetations (Image A) attached to the atrial and ventricular lead, tricuspid valve with associated severe tricuspid regurgitation, and a PFO (Image B) with a large right to left shunt as a result of large right-sided vegetations (Image C). A pacemaker extraction procedure was planned; however, there was a concern for paradoxical septic embolism across the PFO. As such, an ASD occluder device was temporarily placed across the PFO during the procedure to prevent right-to-left embolization. PFO occlusion dramatically improved hypoxemia during the procedure. The infected pacemaker system was then successfully extracted. The PFO occluder device was subsequently removed at the end of the case, given ongoing bacteremia and the risk of device seeding. The patient recovered well with the resolution of hypoxemia and was discharged however presented again one month later with a stroke. TEE exam showed a large echo-dense lesion straddling the atrial septum through the PFO, likely vegetation that embolized to the left circulation causing the stroke (Image D). The patient is currently awaiting cardiac surgery for definitive treatment once medically stable. Pacemaker-associated infective endocarditis can lead to mechanical complications, including tricuspid regurgitation and rarely shunting across the atria, causing severe hypoxemia as in our patient. There are no clear guidelines regarding the management of such atrial defects with shunting peri-device extraction to prevent systemic embolization of vegetations.

Assessment of Nit-Occlud atrial septal defect occluder device healing process using micro-computed tomography imaging.

After percutaneous implantation of a cardiac occluder, a complex healing process leads to the device coverage within several months. An incomplete device coverage increases the risk of device related complications such as thrombosis or endocarditis. We aimed to assess the device coverage process of atrial septal defect (ASD) occluders in a chronic sheep model using micro-computed tomography (micro-CT). After percutaneous creation of an ASD, 8 ewes were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N = 5). After heart explant, the device coverage was assessed using micro-CT (resolution of 41.7 μm) and was compared to histological analysis. The micro-CT image reconstruction was performed in 2D and 3D allowing measurement of the coverage thickness and surface for each device. Macroscopic assessment of devices showed that the coverage was complete for the left-side disk in all cases. Yet incomplete coverage of the right-side disk was observed in 5 of the 8 cases. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology sections. Surface calculation from micro-CT images of the 8 cases showed that the median surface of coverage was 93±8% for the left-side disk and 55±31% for the right-side disk. The assessment of tissue reactions, including endothelialisation, after implantation of an ASD occluder can rely on in vitro micro-CT analysis. The translation to clinical practice is challenging but the potential for individual follow-up is shown, to avoid thrombotic or infective complications.