Emergency Bedside Transoesophageal Echocardiography‑guided Atrial Septal Defect Closure Without Fluoroscopy after Left Ventricular Assist Device Implantation

Implantation of a left ventricular assist device in the presence of a pre-existing patent foramen ovale or an iatrogenic atrial septal defect (ASD) may predispose patients to significant right-to-left shunting, resulting in critical hypoxaemia. In such cases, the appropriate treatment modality has been intervention with transoesophageal echocardiography-guided ASD closure using fluoroscopy. ASD closure without fluoroscopy to reduce radiation exposure has been discussed but not properly explored. We present a case of a 72-year-old patient with a history of left ventricular assist device placement complicated by critical hypoxaemia secondary to a large residual ASD who underwent emergency bedside treatment using transoesophageal echocardiography without fluoroscopy. Although ASD closure without fluoroscopy is not well established, this case highlights a novel technique to promptly and successfully treat critical hypoxaemia in patients with significant shunting.