Abstract
Atrial septal defect is commonly treated with percutaneous closure due to its high efficacy and safety; however, late complications may still occur. We report a case of a 49-year-old male who underwent closure of a secundum atrial septal defect using a non-polyvinyl alcohol membrane device (Cocoon 40 mm) with initially successful results and no residual shunt during the first two years of follow-up. Four years later, the patient developed palpitations and reduced exercise tolerance. Transthoracic and transesophageal echocardiography revealed multiple left-to-right shunts distributed within the device, suggesting late recanalization. Cardiac multi-slice computed tomography was performed for detailed structural assessment and procedural planning. The patient underwent percutaneous intervention with deployment of an Amplatzer Vascular Plug II within the previous device. Post-procedural imaging demonstrated near-complete closure of the shunts with hemodynamic improvement. This case highlights the importance of long-term follow-up and the role of advanced imaging in guiding management. Percutaneous intervention may be a feasible alternative to surgery in selected cases.
