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(A) A surgical aortic punch (ACP Japan, Tokyo, Japan) was used to create a 4.5-mm fenestration. (B) Fenestration on the GORE® CARDIOFORM ASD atrial septal defect occluder device (arrow). (C) Interatrial shunting through the fenestration after implantation on transesophageal echocardiography (arrow).
