Successful percutaneous closure of an extremely large secundum atrial septal defect during pregnancy

Abstract

Atrial septal defects (ASDs) are one of the most of the most common acyanotic congenital heart lesions. Awareness of potential clinical presentations and complications during pregnancy is essential for those managing these patients. We report successful percutaneous closure of an extremely large secundum ASD, using the largest available percutaneous ASD closure device in a 27-year-old pregnant female. Large ASDs may have their initial clinical presentation and diagnosis during pregnancy. If indicated, percutaneous closure can be performed safely. Only a very small number of cases have previously reported this being performed safely during pregnancy.

Keywords: Atrial septal defect (ASD); percutaneous closure; pregnancy.

Figure 1

Echocardiographic images prior to ASD closure. (A) Trans-thoracic echocardiographic apical four chamber images with the large defect shown without colour Doppler. The right ventricular basal and mid measurements were 3.9 and 3.7 cm respectively. Right ventricular fractional area change was 36%; (B) the ASD and inter-atrial shunting is highlighted with colour Doppler; (C) 3D trans-oesophageal echocardiographic image of the right atrial view of the inter-atrial septum. The large atrial septal defect is displayed which measured 31×35 mm² on this image. ASD, atrial septal defect.

Figure 2

Trans-oesophageal images of the 40 mm Occlutech device following deployment with excellent coverage of the defect and sufficient rim attachment at all margins.