case_images: PMC2921521_01
case_images: Transesophageal pictures of the atrial septal defect before closure a) Short axis view showing an 8 mm defect with a deficient anterosuperior rim behind the aorta b) Same view with color flow mapping showing left-to-right shunt
case_images: APC-3-68-g001.jpg
case_images: PMC2921521_01_APC-3-68-g001.jpg
case_images: F0001
case_images: TTE findings and showed an 8 mm ASD with a deficient anterosuperior rim [Figure 1].
case_images: Transesophageal picture of the procedure displaying the guide wire crossing the atrial septal defect. The base of the right atrial appendage had been punctured with a 17 gauge needle
case_images: APC-3-68-g002.jpg
case_images: PMC2921521_01_APC-3-68-g002.jpg
case_images: F0002
case_images: This location was chosen as the entry site after we made sure it would provide the straightest wire course toward the left atrium by pushing the right atrial wall with the index finger tip in various locations and assessing the angle by TEE. The ASD was then crossed using the standard 0,038" J tip short guide wire that came with the short percutaneous sheath [Figure 2a]. This sheath was then carefully advanced over the wire towards the left atrium until the pre-marked point reached the right atrial wall [Figure 2b].
case_images: Surgical view of the heart after a median sternotomy (surgeon's perspective). A 7 Fr sheath was placed in the left atrium through the base of the right atrial appendage over the guide wire. The right atrial and right ventricular dilatation is conspicuous
case_images: APC-3-68-g003.jpg
case_images: PMC2921521_01_APC-3-68-g003.jpg
case_images: F0003
case_images: TEE probe had to be pulled up for some seconds in order to avoid compression of the posterior LA wall and make room for full deployment of the left atrial disk [Figure 3].
case_images: Still fluoroscopic frame performed with a portable C arm equipment showing the left atrial disk being deployed in the left atrium after the transesophageal probe had been pulled up, to avoid compression of the left atrium
case_images: APC-3-68-g004.jpg
case_images: PMC2921521_01_APC-3-68-g004.jpg
case_images: F0004
case_images: The left disk approached the interatrial septum at a perfect angle, coming in a parallel fashion toward it [Figure 4a and b]. The right disk was carefully deployed in the right atrium using the "two-hand" technique, by simultaneously and very slowly retracting the sheath and pushing on the delivery cable [Figure 4c]. TEE [Figure 4d]. There was complete closure of the
case_images: Transesophageal echocardiography pictures during implantation. a) The left atrial disk is seen deployed in the left atrium coming in a parallel fashion toward the septum. b) The left atrial disk is seen very close to the septum and the waist is within the defect. c) The right atrial disk is seen deployed in the right atrium still attached to the delivery cable. d) The device is seen in a perfect position after it had been released from the delivery cable. There is no prolapse of the device through the anterior rim of the defect
case_images: APC-3-68-g005.jpg
case_images: PMC2921521_01_APC-3-68-g005.jpg
case_images: F0005
case_images: ASD immediately after release of the device [Figure 5a and b]. The chest was closed in the usual fashion and the postoperative period was unremarkable, with the child being extubated uneventfully the following day. A significant improvement in the respiratory pattern was noted, which allowed for a progressive weaning from the oxygen.