Closure of complex and large secundum ASD: Is it possible to close by device and by zero fluoroscopy?

Transcatheter closure has become a well-established alternative to surgery for suitable secundum Atrial Septal Defect (ASD). Although complex ASD such as those with multiple fenestrations, large size, deficient rims, or septal malalignment are often managed surgically, recent cohort studies have demonstrated successful percutaneous closure in many of these challenging cases using current devices and techniques. Advantages of percutaneous ASD closure are minimally invasive procedure, shorter hospital stay, reduced procedural risks, cosmetic benefits (no surgical scar on the chest), faster recovery, cost-effective, excellent efficacy, safe for older or high-risk patients, and can be performed with zero or minimal fluoroscopy. A 24-year-old woman, a 25-year-old woman, a 38-year-old woman, and a 69-year-old man presented with exertional dyspnea accompanied by clinical signs of pulmonary hypertension. Transesophageal echocardiography (TEE) identified a large ostium secundum ASD, measuring 35 mm, 33 mm, 40 mm, and 32 mm in diameter, respectively. Transcatheter ASD closure by device with zero fluoroscopy and TEE guidance during the procedure was chosen to close ASD with its own challenges and successfully closed ASD without complications during and after the procedure. Technological advancements now allow closure of even large ASD using devices. While this method is standard, complications can occur in complex cases — though none were observed in our patients.