Objectives: Catheter closure of secundum defects using Amplatzer septal occluders utilises fluoroscopic and echocardiographic guidance. We report our experience in patients with altered anatomy of interatrial septal plane (IASP) who pose challenges. Methods: Patients who underwent device closure of secundum defects, with altered IASP were analyzed. Interatrial septal plane was altered in severe kyphoscoliosis, atrial septal malalignment with multiple atrial septal defects, juxtaposed atrial appendages with altered IASP, anatomically corrected malposition with coronal IASP, interupted inferior venacava with azygos continuation (Figure). Multiple pulmonary venous angiogram were done in these patients to orient the IASP on fluoroscopy; different transesophageal planes were recorded to get the best visualisation of IASP.
Results: 8 patients with secundum atrial septal defects (age range 2-30 years) had a different IASP, four were patients with malalignment between the primum and secundum septum with multiple defects, one with severe thoracic kyphoscoliosis, one with juxtaposed atrial appendage, one with coronal IASP associated with anatomically corrected malposition of great arteries, one with interupted inferior venacava with azygos continuation. Flouroscopic and transesophageal view were initially selected to clearly delineate IASP and these unusual angles guided device deployment. Post deployment, levophase of pulmonary arteriogram was routinely observed to visualize IASP and alignment of the device to the septum. Device closure was successful in all patients with no complications. On a follow up ranging 3 months to 5 years, there were no residual flows.
Conclusions: Safe device closure of atrial septal defects in altered IASP proves the versatility of the nitinol septal occluders.