Perforation of the aortic sinus after closure of atrial septal defects with the Atriasept occluder.

Percutaneous atrial septal defect closure is routinely performed nowadays because of the ease of implantation as well as the low complication rate. The Atriasept ASD occluder is a low profile, double disc device; over the years several modifications have been made. We report two cases of aortic sinus perforation by the Atriasept ASD occluder (model 2007). Two asymptomatic patients, in whom the device was implanted, were noticed to have metal projecting into the aorta. Real-time fluoroscopy showed fractures of the outer metal ring with abnormal movement of one of the struts of the device. One patient is being conservatively managed and in the other the device was surgically removed due to the presence of a second ASD, which needed closure. Transesophageal echocardiography and fluoroscopy may be necessary to identify this potentially life-threatening complication of this device.