Laceration of atrial septum during balloon sizing of atrial septal defect.

We read with great interest the recently published case report by Alsaileek et al. in the European Journal of Echocardiography on laceration of atrial septum during balloon sizing. We had already reported about tear of atrial septum during balloon sizing of atrial septal defect (ASD) in a 20year-old female. Balloon sizing was attempted with Amplatzer sizing balloon (Amplatzer sizing Balloon, AGA medical corporation, 682 Mendelssohn Avenue, Golden Valley, MN-55427) (length, 24 mm; maximum volume, 30 ml). At partial inflation a good indentation was obtained which slowly disappeared without further increase in the balloon volume. Trans-thoracic echocardiography (TTE) followed by trans-esophageal echocardiography (TEE) revealed a tear in the inferior margin of the septal defect. The patient was referred for surgical closure where a tear in the inferior rim of the ASD was found which extended down the septum up to the opening of inferior vena cava, with a small hematoma. Patient underwent repair of the tear and pericardial patch closure of the defect. In our patient we suspected the tear because the waist disappeared over time, which was confirmed by TTE. In the case reported in this journal echogenic shadows were noted at atrial septum during the procedure which was confirmed as laceration at surgery. This laceration involved the superior and posterior aspects of the atrial septum, while our patient the tear extended from the inferior rim of the defect. Alsaileek et al. used Meditech balloon for sizing the defect employing the pull-through technique. It is not clear whether Alsaileek et al. used a fluoroscopy-guided or TEE-guided technique for ASD sizing. The procedure in our case was