device-induced perforation of right atrium following interventional closure of atrial septal defect (asd)

this is a case presentation of a 26-year-old woman with a moderate-sized atrial septal secundum defect (17mm) who underwent catheterism, during which an amplatzer septal occluder number 26 was inserted successfully. on the second postoperative day, she deteriorated and a clinical examination showed a typical tamponade. after a percutaneous aspiration of the pericardial cavity and transient improvement in vital signs, a pig-tail catheter was inserted percutaneously emergently, and the patient was transferred to the operating room in a preshock state. during the operation, an active bleeding point in the superoanterior aspect of the right atrium near the aortic root was detected, which was repaired by direct suture and pericardial patch reinforcement. the amplatzer device was removed and the atrial septal defect was repaired with a pericardial patch . a lethal complication of the interventional closure of atrial septal defect, properly treated by an emergent intervention and operation, is presented and discussed herein.