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Objective: Percutaneous closure of atrial septal defect is a well-established procedure and has evolved to become the standard of care due to its many advantages. However, atrial septal defect closure devices covered with polyvinyl alcohol membrane could cause recurrent significant shunts due to a spontaneous polyvinyl alcohol membrane perforation. To investigate whether spontaneous polyvinyl alcohol membrane perforation developed in our patients who had implanted with CARDIA Ultrasept atrial septal defect occluder (Eagan, Minnesota, USA) that covered with Polyvinyl Alcohol membrane. Methods: We retrospectively rewieved all patients with a diagnosis of secundum type atrial septal defect who underwent percutanoues closure with CARDIA Ultrasept prosthesis. Results: Ten patients aged 4 to 56 years who underwent atrial septal defect closure with UItrasept device were included. During a median 26 months follow up period, we detected a four cases of polyvinyl alcohol membrane failure. In 3 patients, perforation of polyvinyl alcohol membrane caused significant left to right shunt that required re-intervention, while in one patient it caused minimal residual shunt. The devices were used were 14 mm (two patients), 16 mm (one patient) and 30 mm (one patient). Two patients underwent surgical device removal and pericardial patch closure. One patient underwent device in device procedure. Residual shunts were not occured in after reinterventions. Conclusion: Polyvinyl alcohol membrane perforation is rare and can require reintervention. Operators have to be aware of this malfunction.

Spontaneous Perforation of Polyvinyl Alcohol Membrane: A Rare Cause of Atrial Septal Occluder Failure