Key result
Deployment of a custom fenestrated 48 mm Figulla septal occluder successfully closed a 44 mm ASD in a patient with restrictive LV physiology, maintaining a patent fenestration at 4 years.
Case Report (n=1)
Transcatheter closure of extremely large (44 mm) atrial septal defects is feasible using a custom 48 mm fenestrated device, even in the presence of restrictive left ventricular physiology.
Answers are grounded in this paper and cite their sources.
Supports individualized device selection for complex ASDs; leaves open need for multicenter validation before routine adoption.
Atrial septal defects (ASDs) measuring <38 mm are referred for transcatheter closure. Availability of larger devices up to 46 mm extended the inclusion criteria. An elderly hypertensive male with a 44 mm secundum ASD and coexistent sick sinus syndrome and atrioventricular (AV) nodal block presented with syncope. Balloon interrogation unmasked restrictive left ventricular (LV) physiology. After AV synchronous pacing, balloon-assisted deployment of a custom fenestrated 48 mm Figulla septal occluder (Occlutech Inc., Schaffhausen, Switzerland) prevented a rise of LV end-diastolic pressures beyond 12 mmHg. Echocardiogram and computed tomography after 4 years confirmed a patent fenestration and favorable remodeling. This report of the clinical use of the largest ASD device demonstrated the feasibility of closure of extremely large defects despite a restrictive LV.
No takes yet. Share an insight, caveat, or question.
Sivakumar et al. (2023) conducted a case report in Atrial septal defect with restrictive left ventricular physiology (n=1). Custom fenestrated 48 mm Figulla septal occluder was evaluated on Patent fenestration and favorable remodeling. Deployment of a custom fenestrated 48 mm Figulla septal occluder successfully closed a 44 mm ASD in a patient with restrictive LV physiology, maintaining a patent fenestration at 4 years.
Synapse has enriched 10 related papers. Consider them for comparative context: