the art of defining cardiac morphology

Morphology of ASD associated with Occluder embolization

The 'Open Door' Morphology

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Looking at the morphology of the atrial septal defects from an interventionalist's point of view, there appears to be a few characteristics one needs to identify. The spiral morphology is one that is clearly associated with device embolization. The ‘open door’ morphology is another variation which is very important to identify before deciding on the type of device suitable for the defect closure. In this type of defects, there is a well-defined gap between the flap of the oval fossa and the anterio-superior margin of the defect as illustrated above. This gap is formed between the limbus of the Oval Fossa and the remaining septum. There is usually inadequate anterio-superior rim; hence latching the right atrial disc in the right atrial aspect in this region is the main problem. In this situation the inappropriately placed device migrate to the left side. If the gap between the flap and the rim is large and the flap stiff or widely separated to be brought towards the rim then device closure will be difficult. The gap is wide and the flap of the septum cannot be brought together between the two discs of the ASD device then it would clearly lead to embolization. A non self centering device with wider disc margins would close these defects than a standard ASD device. The technique is more like closing an open door than closing a hole with a lid.

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