50. Successful percutanous closure of spiral atrial septal defect

Device occlusion of secundum septal defects has become an accepted means of closure in cases where the anatomy of the atrial septum is judged suitable. Selection criteria have included adequacy of the rims around the defect, particularly the inferior margin and the size of the defect in relation to the total septal length. An unusual morphology of atrial septal defect has been described where there is an apparently “double atrial septum” (Roberson, 2006). The terminology around this lesion has been attributed to be the wide separation of the primary atrial septum (primum septum) from the secondary septum (septum secundum) and the “spiral” spatial arrangement of the margins of the atrial septal defect (ASD) has led to the term spiral ASD to describe this arrangement. This has been described to be associated with a high risk of device embolization or technical failure in the placement of an occluder device. We report the echocardiographic findings and outcome of a patient with this form of ASD in whom percutaneous occlusion was successful of which is considered up to date to be the first successful closure of this type of ASD.