Case Presentation:
A 23-year-old male with a history of malignant migraine and two prior episodes of transient ischemic attacks presented for an elective closure of his suspected patent foramen ovale based on a prior bubble study. A prior transthoracic echocardiogram (TTE) revealed an interatrial shunt based on a positive bubble study, with right atrial enlargement, and mild tricuspid regurgitation. A subsequent 2D transesophageal echocardiogram (TEE) confirmed two atrial septal defects and left to right shunt (Figure 1A). 3D TEE showed an aneurysmal atrial septum and multiple defects with areas of 0.74 cm2 and 0.44 cm2 (Figure 1B-D). The patient subsequently underwent a successful placement of a 35-mm Cribriform Amplatzer Septal Occluder (ASO) closure device. TTE at a 2-month follow-up revealed a well-positioned closure device without observed shunting (Figure 1E).