Custom‐Fenestrated Atrial Septal Occluder Devices in Borderline Patients With Pulmonary Arterial Hypertension or Restrictive Left Ventricular Physiology

Operability of patients with atrial septal defects (ASD) and pulmonary arterial hypertension (PAH) is guided by various hemodynamic parameters obtained after acute vasodilator testing (AVT). Fenestrated closure is suggested in gray‐zone of operability as well as restrictive left ventricular (LV) physiology. On‐table fenestrations made in the catheterization laboratory close on follow‐up. Nitinol wire braid and fabric are modified in custom‐fenestrated occluders to create a permanent 5−8 mm communication.