Presentation
A known cardiac patient with an atrial septal defect and occluding device presented for elective lumbar spine MRI.
Patient Data
There is multi-chamber cardiomegaly.
There is a left-sided aortic arch and descending thoracic aorta.
The Amplatzer atrial septal defect occluding device is barely discernible on the portable seated frontal view.
Reverse portable seated frontal view does not improve the assessment.
There is in addition a migrated metallic embolization coil from multiple previous embolizations of an intrapelvic arteriovenous fistula on history.
This coil is within the descending branch of the right main pulmonary artery.
The Amplatzer atrial septal defect occluding device (arrow) is barely discernible on the portable seated frontal view.
Prestenotic dilatation and possible pulmonary arterial thrombosis cannot be excluded on the chest x-ray and the patient was requested to undergo a repeat cardiac assessment with a view to further CT imaging of the chest (CT PA) for reassessment.
The lateral view from a previous visit easily confirms the atrial septal defect occluding device.
Case Discussion
Cardiac occluding devices are sometimes poorly identified on frontal views (both erect and or supine/portable studies) and therefore lateral view and reverse windows need to be assessed especially before any MRI examination is attempted.
Digital radiography has assisted significantly in these assessments due to the ability to manipulate contrast and zoom/pan images when reviewing.
One must identify the radio-opaque markers on the frontal and lateral views and often due to the position and angulation of the devices they are better identified on the lateral views.
The Amplatzer septal occluder (ASO) is a device intended for occluding atrial septal defects in the secundum position via a percutaneous transcatheter route.
There are two types of ASO occluders: The Amplatzer septal occluder (ASO) has a wide waist while the Amplatzer multifenestrated septal occluder "cribriform" type has a narrow waist.
The multifenestrated or cribriform device is a self-expandable double-disc device made from a nitinol wire mesh. The two discs are linked to each other by a short connecting waist that corresponds to the size of the atrial septal defect.
This patient has the multifenestrated device in situ.
This device is MRI conditional and safe at 1.5 and 3 Tesla strengths at which no migration will occur.
Disclosure: I, Ashesh I Ranchod, 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.
Unable to process the form. Check for errors and try again.