• Wang Man, Ma Xinxin, Zhang Yueli, and Li Feng.
• Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Department of Ultrasound in Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Heart Center, Shanghai, China.
• Medicine (Baltimore). 2018 Aug 1; 97 (31): e11612e11612.

RationaleFenestrated atrial septal defect (ASD) occlusion has been performed in patients complicated with severe pulmonary hypertension (PH). Nevertheless, the persistent interatrial residual shunting in the fenestration might increase the risk of paradoxical embolism. Percutaneous closure of fenestrated ASD occluder (ASO) has not yet been reported.Patient ConcernsA 26-year-old patient with a 25-mm ASD and severe PH underwent ASD closure using a Memory ASO with a waist of 32 and 6-mm custom-made fenestration. Echocardiography revealed the fenestration remained 6 mm and the pulmonary artery pressure decreased to the normal range at the 6-month follow-up.DiagnosesPersistent interatrial residual shunting in ASO.InterventionsPercutaneous closure of residual interatrial shunting was performed using a waist of 8-mm ASO under guidance of TEE.OutcomesThe fenestration was successfully closed. Neither thromboembolism nor infection events were noted during the 12-month follow-up after the procedure.LessonsThis case illustrates that percutaneous closure of the residual shunting in fenestrated ASO was feasible and safe for short- and long-term.

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