Delivery sheath tear after modification for ASD closure.

During transcatheter closure of an atrial septal defect with insufficient aortic rim, a standard delivery sheath was modified by cutting a bevel at the distal tip to improve device orientation. The sheath split longitudinally when attempting to recapture the closure device. Troubleshooting allowed a device to be implanted successfully. Pitfalls regarding our sheath modification and methods to overcome prolapse of the left atrial disk into the right atrium are discussed.