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A 50 year old woman who had a secundum atrial septal defect underwent transcatheter closure. The procedure was performed under general anaesthesia with mechanical ventilation. Multiplane transoesophageal images were acquired with a rotational scanner (TomTec). The three dimensional view from the left atrium showed a 26 mm defect whereas the balloon stretched diameter was 27 mm. An Amplatzer septal occluder (28 mm) was successfully introduced. Three dimensional echocardiographic reconstructions of the device were obtained immediately after the procedure. The left atrial view (right) showed a floating thrombus attached to the distal button of the left disk. The thrombus resolved following treatment with heparin without event.