Abstract
BACKGROUND: Severe residual shunts after percutaneous closure of atrial septal defects are unusual. These patients are usually considered candidates for surgery. CASE SUMMARY: We describe the transjugular closure of a residual atrial septal defect with significant left-to-right shunt due to a malpositioned large atrial septal device in a symptomatic 74-year-old female. Transjugular access was chosen first due to the unfavourable position of the device for delivery of a new one from the femoral approach. An overlapping Figulla® Flex II 27/30 mm PFO device was successfully implanted with the guidance of 3D-transoesophageal echocardiography. DISCUSSION: This case demonstrates the safety and feasibility of transjugular access as an alternative to femoral or transhepatic approaches in patients with difficult atrial septal anatomies, who are usually referred for surgery.