Imaging Essentials Before Transcatheter Closure of an Atrial Septal Defect: Detection of an Unusual Contraindication

Currently there are few contraindications to transcatheter closure of secundum atrial septal defects (ASDs). Known device-related complications of percutaneous ASD closure are worsening of aortic regurgitation and cardiac erosion. Interference of a septal occluder with anatomic variant coronaries is a rare but important complication that can result in post-interventional fatalities. We report a woman with ASD and anomalous left circumflex artery arising from the right sinus of Valsalva with a retro-aortic course. Device closure was not attempted in her due to concerns about coronary compression by the device occluder and hence she underwent surgical closure. <Learning objective: Adequate imaging studies to detect coronary variants in patients scheduled to undergo transcatheter atrial septal defect (ASD) device closure are essential. Identifying anomalies that are at risk for compression from the occluder device prevents post-procedural complications. This case study highlights the importance of thorough imaging, including coronary angiogram and computed tomography angiogram to delineate coronary anomalies associated with ASD.>.