StructuralTranscatheter closure of a complex atrial septal defect after occluder device embolization

•Percutaneous closure has become the treatment of choice for ostium secundum atrial septal defects (ASDs).•There are some ASD that cannot undergo successful percutaneous closure, such as those with deficient rims or extremely size of the defect.•Transesophageal echocardiography (TEE) and intracardiac echocardiography (ICE) are well known imaging techniques used in peri-procedural guidance.•The combination of 3D-TEE and ICE allows for a better characterization of the defect and improves visualization during percutaneous closure.•Closure of complex cases of ASD can be achieved percutaneously when using 3D-TEE in combination with ICE.

Percutaneous closure is nowadays considered the treatment of choice of ostium secundum atrial septal defects (ASD). However, transcatheter closure can be highly challenging when we face an ASD with complex morphological features. The combination of different imaging modalities can be very helpful. This case shows the great value of using both intracardiac and real time 3D transesophageal echocardiography for the percutaneous closure of a complex iatrogenic ASD after device embolization.