Percutaneous closure of a very wide interatrial septal defect: clinical case and literature review

Percutaneous transcatheter closure of ostium secundum atrial septal defects (ASD) is the gold-standard treatment, because of a comparable efficacy and less complications than heart surgery. Nevertheless, percutaneous treatment of very large ASD is still considered a challenging procedure and is discouraged for diameters larger than 38 mm, especially when atrial septal rims are absent. These patients are characterized by more frequent complications when a percutaneous approach is attempted. Hence, the treatment of choice is still debated. We report the case of a 75-year-old Caucasian male, admitted for congestive heart failure secondary to a very large ASD. After accurate sizing with transesophageal echocardiography and sizing balloon, percutaneous closure with an Amplatzer Septal Occluder was successfully performed, using few simple tricks.