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Transcatheter Amplatzer septal occluder closure of residual ASD shunt: following StarFlex spring protrusion
  1. Ihab Khatib,
  2. Yetzhak Schwartz,
  3. Avraham Lorber
  1. Correspondence to Dr Avraham Lorber; a_lorber{at}

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A 15-year-old girl was diagnosed as having secundum atrial septal defect (ASD) at infancy. Transcatheter closure of the ASD was performed at 4 years of age, using a StarFlex 33 mm device (NMT Medical, Boston, Massachusetts). One week following implantation, a small residual shunt was noted. Within the first year following the procedure, a protrusion of one of the right-sided nitinol centring springs developed, and the left-to-right shunt had increased (figure 1).

Figure 1

Transoesophageal echo (TEE). (A) Residual left-to-right shunt (S) through the StarFlex device. (B) StarFlex device (astrix) with protruding spring (arrows) into the right atrium (RA). LA, left atrium.

After 10 years of clinical follow-up, the girl was asymptomatic, but the residual shunt increased, and closure was indicated.

A transcatheter closure of the residual shunt was successfully performed by implanting a second 12 mm Amplatzer Septal Occluder (ASO) (AGA Medical Corporation, Plymouth, Minnesota) (figure 2).

Figure 2

Implanting the 12 mm Amplatzer Septal Occluder (ASO) closing the residual shunt through the StarFlex 33 mm device and straightening the protruding spring.

The second device embraced and grabbed the StarFlex, straightening the protruding spring (figure 3). A surgical approach could be the treatment of choice for a protruding spring of the StarFlex device and closure of the residual shunt. We present the transcatheter approach as an attractive alternative to surgery.

Figure 3

Trans-thoracic echocardiography demonstrating the final result with an appropriate position of the Amplatzer Septal Occluder (ASO) with no residual shunt and no bulging StarFlex spring. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.


  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; not externally peer reviewed.