An Imaging-Facilitating Maneuver for Assessment of Petal Orientation During Patch-Like Septal Occluder Deployment.

BACKGROUND

Transcatheter closure of atrial septal defects with the GORE CARDIOFORM atrial septal defect (ASD) Occluder relies on imaging as mechanical stability testing is not recommended. However, disc overlap often obscures petal orientation and septal apposition.

CASE SUMMARY: We describe 3 patients with complex ASD morphologies, including deficient rims and a floppy septum, successfully treated using an "intentional disc separation maneuver" before locking. By gently retracting the delivery slider while maintaining position, a temporary gap was created between the discs, facilitating complementary assessment of petal orientation by transesophageal echocardiography and fluoroscopy. Strictly an imaging aid rather than a mechanical test, this technique enabled accurate assessment in challenging anatomies, such as multiple rim deficiencies, absent aortic rim, and atrial septal aneurysm. Confident deployment was achieved in all cases without complications or residual shunting.

CONCLUSIONS

The "intentional disc separation maneuver" improves diagnostic confidence during conformable ASD occluder deployment in complex cases.