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.