PMC4011672_01
Transesophageal Echocardiography demonstrates secondum ASD, size 1.4 cm.
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Hence, transthoracic and transesophageal echocardiography were performed and showed dilatation of right atrium and right ventricle, and moderate size of ostium secundum ASD (Figure 1).
Moderate tricuspid regurgitation and severe pulmonary HT(RVSP 78 mmHg).
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The defect size measured about 1.4 cm, with significant left to right shunt, moderate tricuspid regurgitation, and severe pulmonary hypertension (right ventricular systolic pressure (RVSP) =74 mmHg (Figure 2).
Closure of ASD with ASD device (Cocoon ).
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The ostium secundum ASD was later closed with a size 28 mm Cocoon  ASD closure device (Figure 3).
Dramatically fall of RVSP from 78 to 36 mmHg after treatment of hyperthyroidism pulmonary embolism and closure of ASD.
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Surprisingly, when transthoracic echocardiography done 2 month after ASD closure, RVSP dramatically fell from 78 to 36 mmHg, which was consistent with his improved clinical symptoms (Figure 4).