Defects in the oval fossa: morphologic variations and impact on transcatheter closure

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Abstract

Incomplete formation of the partition between the two atrial chambers in the region of the oval fossa results in a range of defects, which extend from patent foramen ovale to large secundum atrial septal defects (ASDs). There is wide variation in the morphology of the latter lesions. The spatial orientation of the margins of ASDs relative to the persisting flap valve is not easily definable with standard echocardiographic imaging. Careful evaluation of the morphology is essential in optimizing successful transcatheter closure to minimize complications. The advent of three-dimensional transesophageal echocardiography has changed the understanding of the morphology of these defects and facilitated successful percutaneous closure.