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.