# Percutaneous Transcatheter Closure of Multiple Ostium Secundum Atrial Septal Defects: A Case Report

## TL;DR

A 61-year-old woman with two heart defects had them successfully closed using a minimally invasive procedure with two devices, avoiding surgery.

## Contribution

This case demonstrates the feasibility of using multiple transcatheter devices to close multiple atrial septal defects.

## Key findings

- Two 17 mm and 14 mm ASDs were successfully closed using 11 mm and 18 mm Amplatzer septal occluders.
- Transesophageal echocardiography confirmed no residual shunt after device deployment.
- The staged deployment of devices avoided entanglement and minimized embolization risk.

## Abstract

Ostium secundum atrial septal defects (ASDs) are a common congenital heart defect that are often asymptomatic until adulthood. Percutaneous transcatheter device closure is now a widely accepted form of treatment as an alternative to surgical repair. A 61-year-old woman presented with two secundum ASDs measuring 17 mm (superior) and 14 mm (inferior) with evidence of significant left-to-right shunting along with right ventricular and right atrial enlargement. Under the guidance of transesophageal echocardiography (TEE), the inferior defect was closed first with an 11 mm Amplatzer septal occluder (ASO) (Abbott Medical Inc., IL, USA), and the superior defect was closed next with an 18 mm ASO. The devices were interdigitated and deployed in a staged fashion to avoid entanglement. Immediate TEE and color Doppler confirmed that both devices were well seated across all rims with no residual shunt. In this case, a two-device strategy using ASOs was required due to the defects being spatially distant from one another. Careful preparation through balloon sizing, TEE guidance, and sequential deployment was taken to minimize the risk of device embolization. This case demonstrates that percutaneous transcatheter device closure through multiple devices is a feasible alternative to a surgical patch in patients with multiple ostium secundum ASDs.