Atrial septal defect with anomalous coronary: not always a contraindication for device closure

The co-existence of an ostium secundum atrial septal defect (OS-ASD) and an anomalous circumflex (LCX) artery is rare, with limited literature addressing the device closure in such cases. A middle-aged woman presented to us with dyspnoea on effort which had progressively worsened from New York Heart Association (NYHA) class I to II over 2 years and evaluation revealed a 16 mm OS-ASD along with an anomalous LCX arising from the right coronary sinus with a retro-aortic course. We report this rare case of atrial septal defect (ASD) device closure in a patient with anatomical combination of ASD and an anomalous LCX, suggesting the combination is not always a contraindication for transcatheter device closure.