CONGRESS ABSTRACT

ASDs account for 13% of all congenital heart diagnoses at birth but remain asymptomatic until adulthood, when atrial arrhythmias, paradoxical embolization or pulmonary hypertension can develop. A 46-year-old woman, without significant cardiovascular history, was admitted to Cardiology Department for dyspnea at exertion. TTE showed an ASD OS type with large left-to-right shunt (Qp/Qs >1.5) and right heart volume overload, dilated right chambers (RVD0: 50 mm) with good longitudinal ventricular function (TAPSE: 29 mm), moderate tricuspid regurgitation with PAPs estimated of 45 mmHg (TAPSE/PAPs: 0.64). TEE confirmed the presence of a 2 cm circular defect (2.01 cm at 61°, 1.98 cm at 91°, 1.92 cm at 98°), posterior and with a small IVC rim (PS rim: 0.571 cm at 0°, PI rim: 0.670 cm at 59°, IVC rim: 0.466 cm at 112°) but eligible to percutaneous closure. ASD was intra-procedure measured in 3 different TEE planes (0°, 45° and 90°) estimating the device size by adding 30% to the largest measurement (2.53 cm considering an ASD of 1.95 cm). With sizing balloon ASD balloon-stretched diameter resulted 2.25 cm at fluoroscopy and 2.56 cm with stop-flow CDUS technique. The procedure was therefore performed with the implantation of a 2.6 cm device, with good angiographic and echocardiographic final result. At 1-month follow-up TTE, device resulted in proper position without trivial leak, right chambers were less dilated (RVD0: 42 mm) with good longitudinal ventricular function (TAPSE: 32 mm), residual mild tricuspid regurgitation with PAPs estimated of 42 mmHg (TRV: 3.06 m/s, TAPSE/PAPs: 0.76).