Objectives In patients with atrial septal defects (ASDs) and deficient aortic and/or posterior rim successful deployment of the Amplatzer septal occluder (ASO) is challenging and several times impossible. In this report we describe a modification of the technique (Greek maneuver) of ASD closure using the ASO to circumvent this problem.
Methods and Results During the last 3 years 65 patients with large ASDs and deficient aortic and/or posterior rim underwent catheter closure with the ASO using the “Greek maneuver (median 14.8, range 4 to 52 years).The Greek maneuver is applied when protrusion of the aortic edge of a deployed (using the standard of ASD closure technique) device in to the right atrium is detected by echo. To circumvent this problem the sheath is advanced into the left atrium where the left disk and 2/3 rds of the right disk are deployed. Then the whole delivery system is pushed inward and leftward gently against the left atrial wall. This trick changes the orientation of the left disk which becomes parallel to the septum preventing protrusion of the device into the right atrium. The ASO was successfully implanted and was associated with complete closure in 62/65 (95.3%) patients. There were no early or late complications related to the procedure.
Conclusions The “Greek maneuver is a quite useful trick that works well in preventing the protrusion of the aortic edge of the ASO in patients with large ASDs and deficient aortic and/or posterior rim.