Discussion:
Clear three-dimensional analyzation of these structures is crucial for proper deployment of ASO and Gore Helex Septal Occluder, which are safe and effective percutaneous transcatheter devices used in closure of fenestrated ASDs.4 However, percutaneous transcatheter approach is challenging with additional structural limitations of atrial septal aneurysm, deficient ASD rims, and long inter-defect distances.1 The atrial septal aneurysm may not provide sufficient rims for implantation of standardized ASD occluder and complete closure without residual shunts is difficult to achieve without the use of multiple devices.1 Current literature supports that a single cribriform device is preferred as the large discs stabilizes the aneurysmal septum, and the device itself does not rely on the septum for position stability.2,5 Cribriform ASO device is available in 18-, 25-, or 35-mm sizes and its use had successfully repaired 13 out of 16 cases of fenestrated ASD with aneurysmal atrial septum in one study.2 Our case aims to increase clinician’s awareness of Swiss Cheese ASDs complicated by additional structural defects such as aneurysmal atrial septum, the necessity of 3D imaging in analysis, and highlights the promising outcome in closure with the single Cribriform ASO device.