Transcatheter Closure of Patent Foramen Ovale in A Patient with Aneurysmal Atrial Septum and Multifenestrated Atrial Septal Defect

Introduction: Treatment of patients with concomitant Patent Foramen Ovale (PFO), Atrial Septal Aneurysm (ASA), and multi fenestrated Atrial Septal Defects (mfASDs) is accompanied by many challenges. There may be even a need for different devices in the atrial septum, which is more challenging and costly. Case Presentation: This study aimed to report a case of PFO closure, which turned out to have ASAs and multiple small holes. A Uni occlutech device was used to close the PFO and fenestrations, which was done successfully and without complications. Conclusions: It is important to have a thorough evaluation of the atrial septum to rule in or out the possibility of multiple defects. This is done by accurate interrogation of the atrial septum by color Doppler echocardiography, preferably by transesophageal or three-dimensional echocardiography at the time of catheterization. Multiple small defects or fenestrations nearby may be closed by a single device, which may cover several defects or fenestrations.