Brief CommunicationAorto-Left Atrial Fistula Post-Percutaneous Device ASD Closure
Introduction
Use of percutaneous devices for closure of atrial septal defects (ASD) continues to increase owing to relative safety and ease of implementation compared with traditional surgical repair. Complications such as perforation and displacement requiring surgical intervention have been reported. We describe a case of perforation with intracardiac fistula formation during medium term follow up after ASD device closure.
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Case report
A previously well 17-year-old male presented with exertional fatigue and dyspnea with intermittent cyanotic episodes. Examination revealed a soft ejection systolic murmur with a widely split fixed second heart sound. Electrocardiograph was normal. Transthoracic echocardiogram (TTE) revealed a 20 mm ASD and a deficient aortic rim of 2 mm (other rims: inferior 27 mm, mitral 10 mm, posterior 17 mm, superior 12 mm). Moderate right heart dilatation was evident.
Uneventful device closure was undertaken at
Discussion
Perforation is a rare but life threatening complication of ASD device closure with an incidence of approximately 0.1% [1]. Two retrospective series of cardiac perforation post-ASD device closure have attempted to define those at increased risk of this complication. Divekar et al. [2] identified 24 cases of cardiac perforation after ASD device closure from published literature (Medline search) and medical device regulating agencies in North America and the European Commission, whilst Amin et al.
Conclusion
Transcatheter closure of ASD is generally a successful procedure with low risk, however, perforation is now recognised as a serious potential complication. Appropriate case selection, with particular care in cases with deficient aortic and superior rims, should help to minimise complication rates.
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