Two-dimensional strain appears to be helpful also for the assessment of RV function and its response to correction of volume overload.

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 (Q p :Q s ϭ2.9) and coronary angiography a type RII P coronary anomaly with one single coronary artery originating from the right aortic sinus 1 (Figure 3). While the patient was sedated, a periprocedural transesophageal echocardiogram by balloon sizing demonstrated a 22-mm stretched diameter of the defect ("stop-flow-technique") and a close anatomic neighborhood of the ASD to the left coronary artery (LCA) (Figure 4).A 24-mm Amplatzer septal occluder was securely positioned in the defect and expanded. Because of the anatomic vicinity of LCA and occluder, coronary angiography was repeated before releasing the device. We thereby demonstrated a systolic compression of the LCA by the left atrial disc ( Figure 5). No acute ECG or hemodynamic changes were observed in this situation. After removing the device and placing it on the delivery sheet, the compression disappeared ( Figure 6). To prevent potential chronic vascular injuries by the interfering device, the procedure was discontinued and the patient recommended a surgical ASD patch closure.Despite low peri-and postprocedural complication rates, there are a few reports of sudden deaths during device closure of ASDs. 2 In most cases, erosion with a consecutive cardiac tamponade was proven or suspected. 3 Despite the low incidence, 4 interference of a septal occluder with anatomic variant coronaries may also be a reason for postinterventional fatalities, as ASD patients usually have no coronary angiography on a routine basis. This case emphasizes the importance of adequate periinterventional cardiac imaging to prevent procedure-related complications.

Background-Percutaneous closure of atrial septal defects is well established in children and adults and has been found to improve symptoms and positively influence right-heart remodeling. The aim of this study was to evaluate the efficacy and long-term outcome in adult patients older than 60 years. Methods and Results-The study population comprised 96 patients in the age group of 60 to 84 years. Percutaneous closure was performed effectively in all patients. Functional capacity according to New York Heart Association functional class and peak oxygen uptake (VO 2 max) in the cardiopulmonary exercise testing improved significantly after atrial septal defects closure, especially in patients with a pulmonary-to-systemic flow ratio Ͼ2. Echocardiographic measurements of the right ventricular end-diastolic diameter showed a significant decrease. No device-associated complications were observed, but in 16 patients, paroxysmal atrial fibrillation occurred after device implantation. Conclusions-Percutaneous atrial septal defects closure can be performed safely and with minimal risk even in elderly patients. They profit in terms of symptom reduction, improvement of exercise capacity, and right-heart remodeling.(Circ Cardiovasc Intervent. 2009;2:85-89.)