{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T20:02:38Z","timestamp":1787169758727,"version":"build-2736575974"},"reference-count":9,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Atrial septal defects (ASDs) measuring &lt;38 mm are referred for transcatheter closure. Availability of larger devices up to 46 mm extended the inclusion criteria. An elderly hypertensive male with a 44 mm secundum ASD and coexistent sick sinus syndrome and atrioventricular (AV) nodal block presented with syncope. Balloon interrogation unmasked restrictive left ventricular (LV) physiology. After AV synchronous pacing, balloon-assisted deployment of a custom fenestrated 48 mm Figulla septal occluder (Occlutech Inc., Schaffhausen, Switzerland) prevented a rise of LV end-diastolic pressures beyond 12 mmHg. Echocardiogram and computed tomography after 4 years confirmed a patent fenestration and favorable remodeling. This report of the clinical use of the largest ASD device demonstrated the feasibility of closure of extremely large defects despite a restrictive LV.<\/jats:p>","DOI":"10.4103\/apc.apc_126_22","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T07:21:54Z","timestamp":1680506514000},"page":"52-55","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Experience with the largest custom-made 48 mm fenestrated atrial septal occluder device and its 4-year follow-up"],"prefix":"10.4103","volume":"16","author":[{"given":"Kothandam","family":"Sivakumar","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4,4]]},"reference":[{"key":"R1-20240901","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jcin.2013.02.005","article-title":"Transcatheter device closure of atrial septal defects:A safety review","volume":"6","author":"Moore","year":"2013","journal-title":"JACC Cardiovasc Interv"},{"key":"R2-20240901","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1002\/ccd.27957","article-title":"Feasibility, safety and midterm follow-up of patients after nonsurgical closure of atrial septal defects using very large 40-46 mm nitinol septal occluders","volume":"93","author":"Sivakumar","year":"2019","journal-title":"Catheter Cardiovasc Interv"},{"key":"R3-20240901","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.hlc.2013.07.020","article-title":"Transcatheter closure of secundum atrial septal defects:Results in patients with large and extreme defects","volume":"23","author":"Romanelli","year":"2014","journal-title":"Heart Lung Circ"},{"key":"R4-20240901","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1002\/ccd.24633","article-title":"Feasibility and safety of transcatheter closure of atrial septal defects with deficient posterior rim","volume":"81","author":"Papa","year":"2013","journal-title":"Catheter Cardiovasc Interv"},{"key":"R5-20240901","first-page":"5","article-title":"Balloon assisted technique for closure of large atrial septal defects","volume":"10","author":"Dalvi","year":"2008","journal-title":"Images Paediatr Cardiol"},{"key":"R6-20240901","doi-asserted-by":"crossref","first-page":"S2848","DOI":"10.21037\/jtd.2018.02.53","article-title":"Electrical disorders in atrial septal defect:Genetics and heritability","volume":"10","author":"Aoki","year":"2018","journal-title":"J Thorac Dis"},{"key":"R8-20240901","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s13019-017-0639-8","article-title":"Midterm follow-up of transthoracic device closure of an atrial septal defect using the very large domestic occluder (44-48 mm), a single Chinese cardiac center experience","volume":"12","author":"Chen","year":"2017","journal-title":"J Cardiothorac Surg"},{"key":"R9-20240901","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/1522-726X(200102)52:2<177::AID-CCD1043>3.0.CO;2-G","article-title":"Masked left ventricular restriction in elderly patients with atrial septal defects:A contraindication for closure?","volume":"52","author":"Ewert","year":"2001","journal-title":"Catheter Cardiovasc Interv"},{"key":"R10-20240901","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jjcc.2014.09.002","article-title":"Current concept of transcatheter closure of atrial septal defect in adults","volume":"65","author":"Akagi","year":"2015","journal-title":"J Cardiol"}],"container-title":["Annals of Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_126_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:12:59Z","timestamp":1787166779000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/apc.apc_126_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/apc.apc_126_22","relation":{},"ISSN":["0974-2069","0974-5149"],"issn-type":[{"value":"0974-2069","type":"print"},{"value":"0974-5149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"assertion":[{"value":"2022-10-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}