Aguiar Rosa, SFerreira, Fde Sousa, LFiarresga, AMartins, JDGalrinho, AAgapito, AFazendas, PPinto, MFCruz Ferreira, R2018-03-062018-03-062017-06Rev Port Cardiol. 2017 Jun;36(6):475.e1-475.e3.http://hdl.handle.net/10400.17/2935A 39-year-old woman underwent uneventful percutaneous occlusion of an ostium secundum atrial septal defect (ASD) with a 22 mm Ultrasept ASD Occluder®. Transesophageal echocardiography (TEE) performed two years after implantation revealed a de novo residual left-to-right shunt through the correctly implanted device. Three-dimensional transesophageal echocardiography (3D TEE) further clarified this finding by showing a perforation of the device membrane coating. The patient underwent transcatheter closure of the residual shunt with a 20 mm Ultrasept PFO®device. The procedure was guided by fluoroscopy and real-time 3D TEE. At the end of the procedure 3D TEE documented correct device deployment with complete defect coverage and absence of residual shunt.engHSM CARHSM CAR PEDCardiac Surgical Procedures/methodsEquipment FailureHeart Septal Defects, Atrial/surgeryRemission InductionSeptal Occluder Devicejournal article10.1016/j.repc.2016.09.020