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A 39-year-old man presented with a history of gradually progressing exertional dyspnoea. He had 2/6 systolic murmur in the second left intercostal space. ECG revealed right bundle branch block. Transthoracic echocardiography showed ostium secundum atrial septal defect (ASD) with pulmonary to systemic flow ratio of 2.5. Right ventricular systolic pressure was 47 mmHg. Prior to planned ASD closure with an Amplatzer occluder transoesophageal echocardiography (TEE) was performed (Panels A and B).TEE confirmed …

Rare coronary anomaly coexisting with atrial septal defect: contraindication to Amplatzer occluder implantation