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Image challenge
Atrial septal defect closure in conotruncal defects: a cautionary tale
  1. Rita Ataíde Silva,
  2. Duarte Martins,
  3. Rui Anjos
  1. Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
  1. Correspondence to Dr Rita Ataíde Silva, Paediatric Cardiology, Hospital de Santa Cruz, Carnaxide 2790-134, Portugal; ritataide{at}gmail.com

https://doi.org/10.1136/heartjnl-2020-316861

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    Clinical introduction

    The authors present an image obtained from a routine cardiac magnetic resonance (CMR) examination performed on a 13-year-old boy who had undergone truncus arteriosus type I repair in infancy. Surgery had been unremarkable. An atrial septal defect (ASD) had been left open for atrial decompression. At the age of 3, percutaneous closure was proposed on the grounds of persistent cyanosis, fatigue and right ventricular dilatation. Closure of the defect was achieved with an 11 mm Amplatzer septal occluder (ASO) device, now well visualised in figure 1.

    Figure 1

    Cardiac magnetic resonance (CMR) image, short-axis view.

    Question

    What serious complication was narrowly avoided in the closure procedure?

    1. Erosion due to a short aortic rim.

    2. Device embolisation due to suboptimal final position.

    3. Device-mediated aortic dissection.

    4. Myocardial ischaemia …

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    Footnotes

    • Twitter @Ritataide

    • Contributors All authors have written and discussed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.