Cardiac perforation during patent foramen ovale closure sealed with an amplatzer PFO occluder

Percutaneous patent foramen ovale (PFO) closure is increasingly performed for a variety of different conditions and is usually relatively straightforward, with a low adverse event rate and virtually no mortality. In cases with a long PFO tunnel, the "puncture technique" -- utilizing a transseptal puncture -- is performed to achieve better apposition of the septum primum to the septum secundum, and to avoid device deformity. Even though transseptal puncture can be safely performed by experienced operators, there is still a 1-2% risk of cardiac perforation. We report a novel technique to percutaneously close a cardiac perforation that occurred while using the puncture technique for PFO closure using an Amplatzer PFO Occluder. The PFO occluder successfully sealed the perforation, prevented development of cardiac tamponade and avoided the need for surgical intervention in a frail patient. This technique can be applied to other cardiac chamber perforations, especially if iatrogenic. This case illustrates the need to be thoroughly familiar with the cardiac anatomy and to avoid "instinctively" withdrawing the equipment once perforation occurs.