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An asymptomatic 13 year old girl was found to have a fixed and widely split second heart sound on a routine examination. There was also a grade 2/6 systolic ejection murmur heard best at the left upper sternal border. The ECG showed right atrial and ventricular enlargement with right axis deviation. The chest x ray revealed mild cardiomegaly with increased pulmonary blood flow. Transthoracic echocardiography displayed a 16 mm secundum type atrial septal defect (ASD) with a Qp:Qs of > 4.0:1.0. The defect was closed percutaneously with a 24 mm Amplatzer ASD occluding device. Transthoracic echocardiography (panel A) and cardiac magnetic resonance imaging (panel B) non-invasively confirmed the appropriate placement of the device in regard to the atrial septum and adjacent cardiac structures. No residual shunt, impairment of the atrioventricular valves, or obstruction of the coronary sinus was found. The post-interventional course was uneventful. The observation period is 11 months. Transoesophageal imaging seems avoidable for routine follow up.
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