Atrial septal defect (ASD) closure device

Case contributed by Hilary Bowman

Presentation

History of ASD s/p closure presents with chest pain.

Patient Data

Age: 45 years
Gender: Female

Two mildly radiopaque discs connected by a central waist with corresponding radiopaque dot markers are seen in the right atrium and left atrium in the region of the atrial septum (best seen in lateral view), consistent with an ASD closure device.

No cardiomegaly, pulmonary vascular congestion, or right atrial enlargement. Heart and pulmonary vascularity appear normal.

No focal pneumonia, effusion, or pneumothorax.

The osseous structures are intact.

The upper abdomen appears normal.

Case Discussion

Atrial septal defects (ASDs) are among the most common congenital heart defects. Left-to-right shunting can lead to right heart enlargement and dysfunction, with some patients developing pulmonary hypertension

Closure of an atrial septal defect (ASD) is done surgically or, in select patients with a secundum ASD, via a percutaneous device. Contemporary ASD closure devices include the Amplatzer Septal Occluder, Gore CARDIOFORM Septal Occluder, Occlutech ASD Occluder, the Ceraflex ASD Occluder, and the Nit-Occlud ASD-R. Devices previously in use include the CardioSEAL Septal Occlusion System, the STARFlex device, and the Gore HELEX.

Many of these devices use a nickel-titanium alloy called nitinol, which is mildly radiopaque as seen in our patient. This device can be difficult to appreciate in the frontal view, as it overlays the spinal column. It is more easily viewed in the lateral film.

Disclosure:  I, Hilary Bowman, have no actual or potential ethical or financial conflict of interest in relation to this device. This case is not intended to be a personal endorsement or recommendation of this product.

This case was submitted with supervision and input from:

Soni C Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
Sylmar, California, United States

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