Utility of balloon assisted technique in trans catheter closure of very large (≥35 mm) atrial septal defects

Trans catheter closure (TCC) for atrial septal defects (ASDs) has been in vogue for more than two decades (1). ASD is considered as large when the long axis measurement is ≥25 mm (2-4). In clinical practice, we often encounter defects, which are very large (≥35 mm). The treatment decision for these patients is unclear. Traditional management includes surgical closure, but morbidity of the open-heart procedure, presence of scar and longer hospital stay makes surgical closure unattractive to many patients. The published studies show ASD size more than 25 mm is a risk factor for unsuccessful device deployment (3,5). Size more than 38 mm is generally considered as a contra indication to TCC (6). But the international registry data shows feasibility of deploying 40 mm Amplatzer device in TCC of large defects up to 39 mm (6). Modified device deployment techniques have been suggested to facilitate device alignment and increase the success rates of TCC (3,4,6)