What is it about?
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
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Why is it important?
Device closure of an eccentric and large atrial septal defect may be challenging. Patients should be closely monitored during and after the procedure. Many a time minor cardiac perforation can be managed conservatively or by surgery without explanting the device if device alignment is proper.
Perspectives
Device closure is recommended as class I and level B indication for an ostium secundum atrial septal defect (OS ASD) with suitable anatomy without significant pulmonary arterial hypertension [1]. The anatomy of the atrial defect is the most important factor when deciding between surgery and transcatheter closure [2]. Device closure of an eccentric OS ASD eccentric defect with a large device is challenging and needs technical modifications to avoid unnecessary complications [3-5]. When the ASD has malaligned, eccentric or deficient rims, then the wiring of the left upper pulmonary vein, negotiation of the sheath and dilator and the release of the left atrial disk are challenging and technical modifications are needed for the successful deployment of the device [5].
Dr Ramachandra Barik
All India Institute of Medical Sciences
Read the Original
This page is a summary of: A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large Device, Cureus, July 2022, Cureus, Inc.,
DOI: 10.7759/cureus.27447.
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