Structural Heart Disease > Cases

Transactheter Closure of Atrial Septal Aneurysm (ASA) Associated with Secoundum Atrial Septal Defect (ASD)
- Operator: JingDong Ding, MD
A 63-year-old woman was referred to our clinic because of complaints of shortness of breath during effort for 1 month. Clinical examination was unexceptional except for a 2/6 systolic murmur in the left sternal border second rib area; Chest radiography showed moderate cardiac silhouette enlargement associated with increased pulmonary vascular markings, mainly on the left side (Figure 1). At echocardiography (an HP SONOS 7500 echocardiography system (Hewlett-Packard) with a multiplane transesophageal probe was used), the right atriam (RA) and right ventricle (RV) was moderately dilated, the ventricular septum moved paradoxically, a huge fenestrated congenital atrial septal aneurysm (ASA) associated with secoundum atrial septal defect (ASD) with marked mobility into the right atrium, base diameter >18 mm, (Figure 2). Twelve-lead electrocardiography revealed sinus rhythm and nonspecific abnormalities of the ST segment and the T wave. Cardiac catheterization was performed to evaluate the severity of the pulmonary hypertension. PAP was mild high (40/8 mmHg). RVP was mild high (40/0 mmHg).
Having determined the stretched diameter of the defect, an appropriate closure device (28mm device ) is selected and a suitable transseptal sheath is passed from the femoral vein across the defect into the mid part of the left atrium, avoding the left atrial appendage, mitral valve or pulmonary veins. Using fluoroscopy , the left atrial disc was opened. With echocardiographic imaging, the left atrial disc was drawn into the defect and visualized from the short axis section of the atria. With the left atrial disc touching the atrial septum, and providing no part of the device is prolapsing through to the right atrium, the right atrial disc is then opened by withdrawing the sheath. With the closure device in an optimal position, pulling and pushing on the delivery wire or catheter then confirms the device is secure. Finally, the device is released and colour flow Doppler is used to identify any residual defects. (Figure 3, Figure 4)
A transthoracic echocardiogram after the procedure showed that the device was correctly placed over the interatrial septum(Figure 5). Following the procedure, the patient received aspirin 100mg once daily for 6 months. Complete closure was found in the patient after follow-up at prior to discharge and 3, 6 months post-closure.
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