Three overlapping septal occlusion devices to treat residual shunting across an atrial septal defect
Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRB 853, Boston, MA 02114, USA
* Corresponding author. E-mail address: awaida.jeanpierre{at}mgh.harvard.eduor awaida{at}hotmail.com
A 46-year-old woman with a history of non-ischaemic cardiomyopathy, severe biventricular failure treated with implantable cardiac defibrillator, presented with increasing dyspnoea. She also has a history of diffuse scleroderma and a prior percutaneous closure of an atrial septal defect (ASD).
Her ASD was closed in June 2004 with a 12 mm Amplatzer ASD closure device (Panel A). Two months later, recurrent right-to-left shunting was confirmed by transoesophageal echocardiogram (TEE) (Panel B) and haemodynamic evaluation. The shunt was treated with a second 15 mm Amplatzer ASD closure device (Panel C). Twenty-four hours after procedure, her SpO2 was 96%. A follow-up TEE performed 8 months after the second device implantation again showed right-to-left shunt (Panel D). The patient was treated medically.
One year later, she presented again with worsening dyspnoea associated with decreased oxygen saturation. Because of her co-morbidities, the patient was deemed a poor candidate for surgery. The shunt was closed with a 25 mm patent foramen ovale (PFO) Amplatzer device (Panel E). Post-procedural angiography and TEE confirmed the presence of a well-seated device with no residual shunt (Panel F). Twenty-four hours later, her SpO2 was 98%. Three months after the final procedure, a transthoracic echocardiogram showed well-seated devices and no interatrial shunting; her SpO2 was 99%. To the best of our knowledge, this is the first published report of three sequential devices implanted to close recurrent shunting across an ASD.
Panel A. LAO 30°, cranial 30° view of the first implanted ASD closure device.
Panel B. TEE showing interatrial shunting through the first device.
Panel C. LAO 30°, cranial 30° view of the two implanted devices.
Panel D. TEE showing residual interatrial shunting after implantation of second device.
Panel E. LAO 30°, cranial 30° view of the three implanted devices.
Panel F. TEE with agitated saline showing absence of residual shunting after implantation of the third closure device.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||