case_images: PMC11198926_01
case_images: (a) Two-dimensional transesophageal echocardiography (TEE) with color Doppler showing two atrial septal defects separated by atrial septal tissue, (b) TEE after deploying the first 15 mm Occlutech device closing the smaller 11 mm atrial septal defect; Note the color Doppler across the other defect
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case_images: TEE showed the two distinct ASDs. The first defect was in the posterior-superior part of the septum and measured 12 mm in diameter (D) and was 10 mm away from the second defect, which was in the anterior-inferior septum measuring 15 mm [Figure 1a and b].
case_images: (a) Transesophageal echocardiography showing the two devices closing the first two atrial septal defects, (b) A corresponding three-dimensional transesophageal echocardiography showed the two occluders with the second defect "sandwiching" the first smaller device. The arrow shows the third defect
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case_images: Figulla ASD Occluder sizes 15 and 18 mm (Occlutech Figulla septal occluder (OFSO), Occlutech GmbH, Jena, Germany) were deployed sequentially in the first and second defects using the same delivery 9 Fr sheath [Figure 2a and b]. Following the deployment of each device, traversing the other defect was achieved under the guidance of live 3D TEE.
case_images: Fluoroscopy image (a) and three-dimensional transesophageal echocardiography (b) three occlutech figulla septal occluders closing the three atrial septal defects
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case_images: It measured 20 mm x 11 mm in two orthogonal planes; hence, a 21 mm OFSO was deployed successfully, through a 12 Fr sheath [Figure 3].
case_images: Follow-up 5 years after device closure. Transthoracic echocardiogram with color Doppler showing the device plane (*) from the apical four chambers (a) and the subcostal views (b). RA: right atrium. RV: right ventricle. LA: left atrium. LV: left ventricle
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case_images: On the latest follow-up, 5 years following the procedure, TTE revealed well-seated devices without apparent residual leak and normal right atrial and ventricular sizes [Figure 4].