Combined percutaneous management of an atrial septal defect and coronary artery disease

A 52-year-old female was admitted to rite hospital with a 1-month history of increasing breathlessness, exertional chest tightness, palpitation, and lethargy. Echocardiography revealed a secundum atrial septal defect. Cardiac catheterization confirmed the diagnosis, and the coronary angiogram revealed a critical 90% stenosis in the mid-right coronary artery (RCA). Under general anaesthesia, two 15-mm intracoronary stents were placed in the RCA with an excellent angiographic result. The atrial septal defect was then closed percutaneously using the Angel-Wings atrial septal defect occluder device. Perioperative transesophageal echocardiography confirmed satisfactory positioning of the Angel Wings device and color flow mapping showed ilo residual shunt across the atrial septum. The patient was discharged home the following day. Percutaneous closure of atrial septal defects offers the chance to replace an open heart surgical procedure with a minimally invasive treatment that allows discharge from the hospital on the day after the closure. To date, adult patients who have concomitant coronary artery disease and an atrial septal defect have undergone surgery even if their coronary lesion was amenable to percutaneous treatment with angioplasty. We describe a patient in whom stenting of the RCA and percutaneous closure of an atrial septal defect were performed concomitantly.