Combination of modified techniques for percutaneous closure of a large secundum atrial septal defect

Figures

• 

  Figure 1. Transoesophageal images of device closure of a large secundum atrial septal defect with deficient superior vena cava. A – Four-chamber view (zoom); on the left side: secundum atrial septal defect in the middle part of the septum, dilated right atrium. Good visualization of the present posterior rim and deficient aortic rim; on the right side: TEE with colour Doppler showing a very large atrial septal defect with left-to-right shunt (white star). B – Bicaval view presenting a short superior vena cava rim and thin and floppy inferior vena cava rim. C – Short-axis view focused on the aortic valve showing lack of the aortic rim. D – Sizing balloon catheter inflated across the defect (empty white star) during simultaneous device deployment from the right upper pulmonary vein. E – Final result after release of the device; bicaval view with colour Doppler compare TEE showing typical device conformation with small residual leaks and unobstructed flow from the superior vena cava. F – Final result after release of the device: short-axis view with colour Doppler compare presenting the occluder well positioned on the aorta with small residual flow SVC – superior vena cava, IVC – inferior…

• 

  Figure 2. Percutaneous large secundum atrial septal defect closure with combination of modified techniques. A – A sizing balloon (white star) is inflated with the long sheath and the occluder (black star) ready for deployment in the right upper pulmonary vein. B – The left atrial disc (white arrow) being deployed in the right upper pulmonary vein. C – The left atrial disc (white arrow) fully deployed with the sizing balloon inflated. D – The right atrial disc (white empty arrow) deployed with sizing balloon inflated. E – Gradual deflation of the sizing balloon after both discs have been deployed and progressive conformation of the discs (white arrows) as the balloon is completely deflated. F – Final position of the device after release