Device closure of large atrial septal defects: technical considerations.

Transcatheter closure of secundum type atrial septal defect has become an accepted alternative to surgical closure. Closure of small to moderate-sized atrial septal defects is technically easy and straightforward, however, closure of large atrial septal defects may be technically challenging. We review the available techniques that can be used to secure deployment of the device in good position. These techniques include the use of a specially designed delivery sheath, the 'Hausdorf sheath', or deployment of the device in either right or left pulmonary veins, the use of a dilator or balloon to hold the left disk in the left atrium and the use of a Judkins right coronary guiding catheter to deploy the device.