Sizing Balloon to Facilitate ASD Closure

Sizing Balloon to Facilitate ASD Closure Matthew J. Price, MD

A 37-year-old woman presented with dyspnea on exertion, right-sided cardiac enlargement, and a large ostium secundum ASD with a deficient retroaortic rim, as seen on (A) 2-D TEE and (B) 3-D TEE. C, Initial attempt with a 26-mm ASO device failed as the left atrial disk fell into the RA at the site of the deficient aortic rim (arrow). D and E, A sizing balloon catheter was advanced alongside the delivery sheath through a second venous access, and inflated slightly so that it would push and orient the axis of the left atrial disc parallel to the plane of the IAS (or the sheath more orthogonal to the IAS). F, With this approach, the device was deployed in a stable and successful fashion. Ao, Aorta; ASD, atrial septal defect; ASO, Amplatzer Septal Occluder; IVC, inferior venae cavae; LA, left atrium; RA, right atrium; SVC, superior venae cavae.

230  CONGENITAL ABNORMALITIES, PSEUDOANEURYSMS, AND SHUNTS

KEY POINTS 1. In patient in need of ASD closure and with deficient rims, clockwise rotation may not be sufficient. 2. In these cases, a sizing balloon catheter can be advanced into the LA through a second venous sheath. The catheter is manipulated alongside the left atrial disc to deflect it away from the aorta and orient it parallel to the IAS as the sheath is withdrawn and the right atrial disc is deployed.

A

B

C

D

E

F

G

CONGENITAL ABNORMALITIES, PSEUDOANEURYSMS, AND SHUNTS 231 H