PMC8907262_01
iCTD (arrow) at the connection of the right atrium and inferior vena cava is shown in (A) transthoracic echocardiogram (TTE) and (B) three-dimensional TEE. LA, left atrium; RA, right atrium; CS, coronary sinus; IVC, inferior vena cava.
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F1
TTE. TEE was arranged for the membranous remnants at the right atrium and revealed double ASDs with iCTD at the connection of the right atrium and inferior vena cava (Figures 1A,B).
Large (L) and small (S) ASDs are revealed in (A) cardiac computed tomography and (B) three-dimensional transesophageal echocardiogram. TV, tricuspid valve.
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F2
Cardiac CT showed double ASDs, which were 21.2 and 13.6 mm in size, with iCTD (Figures 2A,B).
EKG during catheterization. (A) ST segment elevation (black arrow) is noted while the coronary sinus was obstructed by the occluder. (B) Recovery to sinus rhythm after we withdrew the device.
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F3
However, transient heart ischemia with presence of ST segment elevation (Figure 3A) was noted and coronary sinus obstruction by the device was thought to be the cause. Hence, we withdrew the device immediately and the ST segment elevation recovered (Figure 3B).
The position of the ASD occluder. (A) The position of the ASD device is initially incorrect with part of the incomplete cor triatiatum dexter clamped and many residual shunts noted under TEE. (B) The position of the ASD occluder is good with a minimal residual shunt and the incomplete cor triatiatum dexter (arrow) is free from clamping by the device.
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F4
Partial involvement of iCTD in the process of device deployment, which resulted in the obstruction of coronary sinus, was determined (Figure 4A). After device movement, we detached the device smoothly, and a minimal residual shunt without iCTD and tricuspid valve clamping was noted (Figure 4B).