Yulius Pattimang, Paskalis Indra
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.