Atrial septal defect closure in conotruncal defects: a cautionary tale

The authors present an image obtained from a routine cardiac magnetic resonance (CMR) examination performed on a 13-year-old boy who had undergone truncus arteriosus type I repair in infancy. Surgery had been unremarkable. An atrial septal defect (ASD) had been left open for atrial decompression. At the age of 3, percutaneous closure was proposed on the grounds of persistent cyanosis, fatigue and right ventricular dilatation. Closure of the defect was achieved with an 11 mm Amplatzer septal occluder (ASO) device, now well visualised in figure 1. Figure 1 Cardiac magnetic resonance (CMR) image, short-axis view. What serious complication was narrowly avoided in the closure procedure? 1. Erosion due to a short aortic rim. 2. Device embolisation due to suboptimal final position. 3. Device-mediated aortic dissection. 4. Myocardial ischaemia …