Imaging essentials before transcatheter closure of an atrial septal defect: Detection of an unusual contraindication

Currently there are few contraindications to transcatheter closure of secundum atrial septal defects (ASDs). Known device-related complications of percutaneous ASD closure are worsening of aortic regurgitation and cardiac erosion. Interference of a septal occluder with anatomic variant coronaries is a rare but important complication that can result in post-interventional fatalities. We report a woman with ASD and anomalous left circumflex artery arising from the right sinus of Valsalva with a retro-aortic course. Device closure was not attempted in her due to concerns about coronary compression by the device occluder and hence she underwent surgical closure. .