Simultaneous Transcatheter Closure of a Persistent Iatrogenic Atrial Septal Defect and Incidental Patent Foramen Ovale.

OBJECTIVE

To describe a transcatheter strategy for simultaneous closure of a persistent iatrogenic atrial septal defect (iASD) and adjacent patent foramen ovale (PFO) using a single Cribriform occluder in a patient with exertional hypoxemia.

KEY STEPS: 1) Preprocedural transesophageal echocardiography (TEE) and bubble study to assess both defects, quantify shunting, and their spatial relationship; 2) selective wire crossing of the iASD under real-time 3-dimensional TEE guidance; 3) deployment of a Cribriform occluder to bridge both adjacent defects; and 4) confirm device stability and adequate closure with postdeployment color Doppler and bubble study.

POTENTIAL PITFALLS: The guidewire may preferentially cross the larger PFO rather than the smaller iASD. Careful assessment of the interdefect distance is essential because widely separated defects may require 2 occluders rather than a single bridging device.

TAKE-HOME MESSAGES: Systematic TEE evaluation can identify a concomitant PFO before iASD closure. In anatomically suitable cases, simultaneous single-device closure can effectively eliminate right-to-left shunting.