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Surgical repair of right atrial perforation which occurred during transcatheter closure of ostium secundum atrial septal defect without disturbing the device: A case report.

B.G.K. Sudhakar, B. Sai Rahul

Transcatheter Techniques (TCT) has largely replaced open surgical procedures in majority of cardiovascular disorders. Ostium Secundum Atrial Septal defect (OS ASD) is a common congenital a cyanotic heart disease especially among adults. Majority of small to moderate sized OS ASDs and some large ones are suitable for percutaneous device closure (class I). However, some large ASDs and non OS ASDs warrant surgical closure. Though safe, complications have been encountered during and after transcatheter closure. These include residual shunts, embolization of the device, device-related thrombosis, erosions and perforations of the heart, infective endocarditis and sudden death. Of all the complications, perforation is the most feared complication with the reported incidence close to 0.1%. Most of the perforations are reported to occur in the first 48 hours after the procedure. However, Delayed perforations have been described by some operators especially of atrial dome and the adjacent aorta which are considered to be vulnerable to device erosions. Cardiac erosions can manifest as hem pericardium, cardiovascular collapse, and sudden cardiac death. Larger devices are used for closure of defects with deficient rims this may increase the risk of friction between the device and the atrial or aortic wall resulting in tissue erosion and perforation. We are presenting a case where tear of right atrial posterior wall occurred while manipulating the delivery sheath and device in Right Atrium (RA).