Cupping of the left atrial disc: a new echocardiographic pointer towards atrial septal defect-device mismatch

We report a case of percutaneous atrial septal defect closure (ASD) in which, despite careful device selection and successful shunt closure, a number of adverse echocardiographic features developed, necessitating surgical extraction of the device and patch closure of the defect. Lessons regarding case selection, device choice, appropriate follow-up and recognition of adverse echocardiographic features can be learned from this experience.