Post Atrial Septal Defect Device Closure Acute Severe Haemolysis: one hole closed, one valve leaked-A Rare Case...

Acute severe haemolysis following atrial septal defect(ASD) device closure is extremely rare, where precise incidence, underlying aetiologies, and optimal management strategies remain inadequately understood. We report a case of significant haemolysis after transcatheter atrial septal defect closure in 10 year old female, possibly related to the interface between the device surface and the high-velocity jet of valvular regurgitation resulting from the abnormal configuration of the device. The presence of a residual shunt, combined with atrioventricular valve regurgitation flow, places pressure on the occluder's discs, leading to increased erythrocyte fragility and subsequent rupture. In our case, haemolysis was initially conservatively managed with fluids, diuresis, and sodium bicarbonate, and the patient was discharged successfully on the 6^th post-procedure day. Surgical retrieval was advised; however, the patient was subsequently lost to follow-up. In this case report, we aim to showcase the pathophysiology, technical pitfalls regarding the procedure and management of acute severe haemolysis that occurred after atrial septal defect device closure. In conclusion, by sharing our clinical experiences and addressing misconceptions and potential risk factors for this serious complication, we aim to provide insights that may enhance future clinical practice and preventive strategies.