Challenges in Atrial Septal Defect Occlusion

Abstract

We present 11 cases of percutaneous transcatheter occlusion of atrial septal defects (ASDs) in adults, including multi-fenestrated ASD, balloon-assisted deployment of ASD occlude, dilator-assisted deployment of ASD occlude, "cobra"-shaped disfiguration of the left disc, ASD with deficient aortic rim, pulmonary vein-assisted deployment of ASD occlude, "high" ASD, large Chiari network, double interatrial septum, snaring a runaway occluder, and right ventricular diastolic dysfunction causing cyanosis. Each case is followed by a practical discussion of the special dilemmas, complications, and challenges that may occur during common procedures.

Assessment of atrial septal defects rims on transesophageal echocardiogram at Shahid Gangalal National Heart Centre, Kathmandu, Nepal

“…2 Deficient aortic rim has been associated with increased risk of device impingement on the aorta. 8 Ostermayer et al found that small aortic rim is independently associated with procedural failure. 9 On the other hand, O'Byrne et al found that deficient aortic rim is highly prevalent but does not seem to increase the risk of adverse outcomes.…”