Pulmonary oedema after percutaneous ASD-closure

Although surgery is the gold standard, percutaneous closure of an atrial septal defect (ASD) is gaining popularity. Nonoperative device closure is applicable only to secundum defects with appropriate anatomic characteristics. A 27-year-old man was referred for closure of a symptomatic secundum type ASD and suffered from a dramatic change in his clinical status due to pulmonary oedema immediately after ASD-closure. The preexisting hypertrophic cardiomyopathy, not known at the moment of the closure procedure, was responsible for this dramatic evolution. Successful occlusion of the left-to-right shunt (resulting in a closure of an "escape mechanism") imparted an acute volume loading to the patient's poorly compliant left ventricle resulting in pulmonary oedema due to hyperacute diastolic heart failure. This case report tries to highlight the haemodynamic features related to ASD closure in the presence of hypertrophic cardiomyopathy. Implications for closure procedures in the presence of poorly compliant left ventricles are discussed.