Staged approach for the management of atrial septal defect in the presence of a small left ventricle and suprasystemic pulmonary pressure

A 29-year-old woman with a symptomatic large atrial septal defect, a small left ventricle with a modest left atrium, mild to moderate nonrheumatic mitral valve incompetence, an apex-forming very large right ventricle and suprasystemic pulmonary artery pressure.

One year of preprocedural drug treatment to lower pulmonary hypertension followed by percutaneous closure of the atrial septal defect with a customized fenestrated device.

Gradual adaptation to the occlusion of the interatrial communication