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Fenestrated Amplatzer atrial septal defect occluder in an elderly patient with restrictive left ventricular physiology
  1. Simon T MacDonald,
  2. Carmelo Arcidiacono,
  3. Gianfranco Butera
  1. Department of Pediatric Cardiology and Adult Congenital Heart Disease, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy
  1. Correspondence to Dr Gianfranco Butera, Department of Paediatric Cardiology and Adult Congenital Heart Disease, Policlinico San Donato IRCCS, Via Morandi 30, 20097 San Donato Milanese (MI), Italy; gianfranco.butera{at}grupposandonato.it

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A 76-year-old man with an atrial septal defect (ASD) had a large left to right shunt, dilated right ventricle and raised estimated pulmonary arterial pressure of 62 mmHg on echocardiography, portending high risk closure. Haemodynamically it was evaluated by test occlusion and sizing with a 24 mm Amplatzer sizing balloon, monitoring left ventricular (LV) pressure via a pigtail catheter for 10 min (figure 1A–C). LV pressure rose from 92/15 to 111/30 mmHg. A 22 mm ASD occluder (AGA Medical, Plymouth, Minnesota, USA) …

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