Different techniques for closure of multiple interatrial communications with the Amplatzer septal occluder

We present three cases of multiple interatrial communications to illustrate the extended use of the Amplatzer septal occluder and to highlight procedural techniques. The first case demonstrates how a single device can be used to close two adjacent defects. It is important to balloon size both defects and to note if balloon occlusion of one defect closes the other and vice versa. The second case demonstrates closure of multiple atrial septal defects using two devices. The technique needed to obtain an "interleaved" position of the two devices is detailed. This technique allows for a lower profile that reduces stress on the devices and surrounding structures and may decrease the risk of thromboembolism and device embolization. The third case describes device closure of a residual defect adjacent to a previous device implanted at an earlier sitting. In this situation, an overlapping position without the option for "interleaving" is inevitable.