Associazione Nazionale Medici Cardiologi Ospedalieri



Transcatheter correction of residual Inferior Sinus Venosus Defect after surgical closure

Granata Giuseppina Lodi (Lodi) – Ospedale Maggiore Di Lodi | Corciu Anca Irina Lodi (Lodi) – Ospedale Maggiore Di Lodi | Oliveri Federico Pavia (Pavia) – Policlinico San Matteo Di Pavia | Bollati Mario Lodi (Lodi) – Ospedale Maggiore Di Lodi | Bedogni Francesco San Donato Milanese (Milano) – Irccs Policlinico San Donato | Mazzarotto Pietro Lodi (Lodi) – Ospedale Maggiore Di Lodi

A 21-year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV-ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event.

The contrast transcranial Doppler (CTD) was positive for right-to-left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left-to-right shunt and severe RLS after Valsalva’s Manovre (>20 bubbles) (fig.A-B). No clear intra-cardiac source of embolization was detected on workup.

After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior-posterior rim towards the IVC (<5 mm). A Figulla Flex II ASD Occluder with the smallest waist of  4 mm was implanted with no evidence of residual intraprocedural shunt; no  intraprocedural complications were observed (fig.C). The 1 month follow-up CTD was negative for RLS.

CONCLUSIONS: Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior-inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case-by-case basis.


1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure.  Cardiovascular Intervention and Therapeutics (2021) 36:256–259

2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002