Device closure of fenestrated atrial septal defects: Use of a single Amplatz atrial septal occluder after balloon atrial septostomy to create a single defect

Abstract

Successful transcatheter device closure of secundum atrial septal defect has achieved worldwide acceptance with the clinical use of the Amplatz atrial septal occluder. However, device closure of multiple fenestrated secundum atrial septal defects remains a challenge for the interventionist and in some cases may be only effectively closed surgically. This case report of multiple fenestrated atrial septal defects represents a further expansion of technologic efforts to improve the results and simplify the mechanism of device closure of fenestrated defects. When device closure with more than one device seems impractical or disadvantageous, consolidation of multiple defects in a fenestrated fossa ovalis by simple balloon atrial septostomy as demonstrated by this case report provides an easy mechanism to allow implantation of a single large device which will effectively close all of the defects. This approach is similar to the surgical approach for resection of the fenestrated membrane with secondary patch closure of the enlarged defect. Excellent and complete closure of a fenestrated secundum atrial septal defect is illustrated in this case report.

Fenestrated Atrial Septal Defect Percutaneously Occluded by a Single Device: Procedural and Financial Considerations

“…When multiple ASDs cannot be closed with one large device or two to three smaller devices, performing an atrial balloon septostomy followed by device closure of the single iatrogenic ASD has been proposed [10]. While it has been successfully accomplished previously, this method carries the risk of creating an unpredictable, irregular, large hole.…”

Intra-operative device closure of multiple atrial septal defects facilitated by a unique atrial septum remodeling technique: initial results and experience in 11 patients

“…Meanwhile, using multiple devices to close them separately also seems to be impossible due to the potential interference between them, although some special devices (Cribriform or PFO Amplazter) have been applied in order to avoid the device interference [8,13]. The method of using balloon atrial septostomy to allow implantation of single device was also reported [14]. The evidence is still limited.…”

Transcatheter closure of multiple atrial septal defects in an adolescent

“…achieved a success rate of complete closure of both ASD in 61% of the 39 patients in whom this was attempted 6 . Alternatively, consolidation of multiple defects in a fenestrated fossa ovalis into a single large defect by simple balloon atrial septostomy followed by implantation of a single large device has been reported to effectively close all the defects 7 . When the defects are widely separated, more than one device is required.…”