Dual-device transcatheter closure of a complex fenestrated atrial septal defect

Fenestrated atrial septal defects pose significant challenges for transcatheter closure due to their complex morphology and the frequent presence of multiple openings. We report a case of a 41-year-old man with cryptogenic stroke found intra-procedurally to have a large, fenestrated ostium secundum atrial septal defect. Successful closure was achieved using two Amplatzer septal occluders—a 24 mm standard and a 30 mm cribriform device. Advanced imaging had a critical role in delineating defect anatomy, guiding individualized device selection, and confirming complete closure. This case highlights the feasibility and safety of dual-device deployment in complex septal anatomies and underscores the importance of comprehensive imaging and flexible interventional strategies in optimizing outcomes. Keywords: Atrial septal defect; Fenestrated ASD; Transcatheter closure; Amplatzer septal occluder; Cribriform Amplatzer device; Dual-device closure.