Interruption of the inferior caval vein complicates device closure of atrial septal defects. We present a case where a simplified technique was used: from right jugular access the delivery system was directly engaged into the left atrium, where the entire septal occluder was deployed. Both discs were aligned with the interatrial septum, after which the right disc was recaptured and re-deployed in the right atrium under tension. This technique will allow device closure of atrial septal defects from the upper caval vein in selected cases.

An atrial septal defect is a rare anomaly in patients with interrupted inferior vena cava, which renders the percutaneous intervention more complex; and hence, innovative approaches should be sought. Dextrocardia further complicates the procedure, and traditional atrial septal device deployment methods cannot be employed. We report a successful percutaneous secundum atrial septal defect closure by a novel deployment strategy along with balloon dilation of associated severe valvular pulmonary stenosis in a patient with dextrocardia and interrupted inferior vena cava.

We present a case of a 31-year-old male with a large atrial septal defect, who was found to have interrupted inferior caval vein with azygous continuation to the superior caval vein, which precluded transcutaneous closure by device. The defect was successfully closed with a 33 mm Occlutech Figula septal occluder using a sub-mammary small thoracotomy incision and per-atrial approach without using cardiopulmonary bypass. The patient was discharged home after 48 hours of procedure.