Transcatheter closure of ruptured sinus of valsalva aneurysm and secundum atrial septal defect with limited inferior rim.

We report a case of a 33-year-old man with Down syndrome and ruptured sinus of Valsalva aneurysm (SOVA) plus large ostium secundum atrial septal defect (ASD) with attenuated inferior rim. He underwent successful transcatheter closure of both defects at two separate procedures with transesophageal echocardiography (TEE) guidance. The combination of these two procedures has not been previously reported. Transgastric echocardiographic views which mimic transthoracic subcostal echocardiographic views provide high quality useful images of the anatomy, hemodynamics, and device placement.