Key result
Percutaneous closure with dual sutured septal occluders successfully seals a giant ASD without residual shunt.
Why the study?
Giant secundum ASDs are generally considered unsuitable for transcatheter closure and often require surgical repair, limiting options for prohibitive-risk patients.
Does percutaneous closure using two sutured occluders achieve successful defect closure in a prohibitive-risk patient with a giant secundum ASD?
Case Report (n=1)
Does percutaneous closure using two sutured occluders achieve successful defect closure in a prohibitive-risk patient with a giant secundum ASD?
Percutaneous closure of giant ASDs exceeding standard occluder sizes may be feasible in prohibitive-risk patients using a novel technique of suturing two devices together.
May support percutaneous strategies in prohibitive-risk giant ASD; leaves open need for prospective validation before broader use.
BACKGROUND: Giant secundum atrial septal defects (ASDs) are generally considered unsuitable for transcatheter closure and often require surgical repair. Innovative percutaneous strategies may provide an alternative in prohibitive-risk patients. CASE SUMMARY: A 75-year-old man with a giant secundum ASD (64.5 × 38.8 mm), severe mitral and tricuspid regurgitation, pulmonary hypertension, atrial fibrillation, cirrhosis, and chronic kidney disease was deemed inoperable. After staged mitral and tricuspid transcatheter edge-to-edge repair, the ASD was successfully closed using two 38-mm septal occluder devices sutured together ex vivo and simultaneously deployed, resulting in stable device position without residual shunt. DISCUSSION: This case demonstrates a novel percutaneous strategy for closure of exceptionally large ASDs exceeding currently available occluder size limits. TAKE-HOME MESSAGE: Percutaneous closure of giant ASDs may be feasible in selected prohibitive-risk patients using coupled occluder devices.
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Giacaman et al. (2026) conducted a case report in Giant secundum atrial septal defect (n=1). Percutaneous closure using two 38-mm septal occluder devices sutured together ex vivo was evaluated on Successful closure without residual shunt. Percutaneous closure of a giant secundum ASD using two sutured 38-mm septal occluder devices was successfully performed in a 75-year-old prohibitive-risk man, resulting in no residual shunt.
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