To close or not to close an atrial septal defect in ischemic cardiomyopathy.

A 67-year-old male presented with a left ventricular ejection fraction of 21% and an atrial septal defect (ASD), the closure of which carries a risk of worsening the patients' clinical situation. The ASD contributed significantly to heart failure according to NYHA class III to IV, on the other hand. Preconditioning, echocardiographic testing, and test closure were carried out in order to minimize the risk and to finally close the defect successfully in behoof of the patient.