Case details
A 7-year-old girl weighing 20 kg, detected to have a heart murmur had a 21-mm ostium secundum ASD with more than 2:1 left to right shunt on transthoracic echocardiography. There was volume overload of the right atrium and ventricle without pulmonary hypertension. There was a prominent Eustachian valve (EV) of the Inferior vena cava (IVC). She underwent transesophageal echocardiography to characterize the ASD rims and suitability for device closure.
Tranesophageal echocardiography (TEE) demonstrated a 23 * 21mm OS ASD with a mitral rim measuring 4.5 mm and IVC rim of 6 mm. The mid-esophageal TEE 0-degree view (Figure 1A, Video 1) demonstrated a borderline mitral rim, with a prominent Eustachian valve very close to the mitral rim in contact with the interatrial septum (Figure 2 A). The other rims appeared adequate for device closure (Figure 1 B, C). She underwent closure of the ASD using a 26 mm Lifetech HeartRTM atrial septal occluder device (Lifetech Scientific, Shenzhen, China). After deploying the LA disc, the device was pulled back across the septum and the waist deployed successfully in the first attempt. The Eustachian valve tissue adjacent to the AV rim prevented migration of the disc and stabilized the device despite a relatively small mitral rim. Figure 3 A-B shows the septal occluder in situ with the rims within the discs and a prominent EV. There was no residual flow, no conduction abnormalities and patient was discharged on Aspirin 5 mg/kg/day for 6 months. The patient is doing well at latest follow up with stable device position and without residual flow at 3rd month follow up.