OBJECTIVE: Percutaneous Closure using Amplatzer Septal Occluder (ASO) is well
known as an effective strategy for the treatment of Atrial Septal Defect (ASD). Unlike
small and moderate sized ASD, large ASD (>8 mm) has been known to be more
challenging to be closed by using ASO given the high risk of device malalignment
and the herniation of the left atrial (LA) disc to the right atrium (RA).
CASE: We present 2 cases of Large Secundum ASD. Case 1 shows a 3 years old
male with a 11-14 mm ASD, while Case 2 shows a 22 years old female with a 34 - 36
mm ASD. Both cases were considered eligible for ASO in terms of the structural
(rims and defect size; measured using Transesophageal Echocardiography / TEE)
and hemodynamics parameters (Obtained by cardiac cathetherization). In Case 1, a
14 mm ASO was advanced using sheath that was firstly placed in right upper
pulmonary vein. While in Case 2, a 40 mm ASO was advanced using sheath that
was placed in left upper pulmonary vein. The sheath was then withdrawed gently,
which opened the LA disc. Confirmation using TEE showed a good alignment of LA
disc to Inter-atrial septal plane without any herniation toward RA. The connecting
waist and the right atrial (RA) disc are then deployed. Evaluation using TEE showed
successful percutaneous ASD closure without residual shunt or any complications.
CONCLUSION: Although challenging, percutaneous closure using ASO has been
proven as a reasonable and effective approach for large ASD.