Atrial Septal Erosion

Figure 1. Contrast TEE Demonstrating Right-to-Left Shunt Through PFO Still frame from contrast transesophageal echocardiography demonstrating the pathway of right-to-left contrast shunting through the patent foramen ovale.

Figure 2. Successful Deployment of Amplatzer PFO Occluder Fluoroscopy image demonstrating the successful deployment of a 25-mm Amplatzer patent foramen ovale occluder with the device appropriately positioned across the patent foramen ovale with stable apposition to the atrial septum.

Figure 3. Contrast TEE Demonstrating Peridevice Right-to-Left Shunt at 6-Month Follow-Up Still frame from contrast transesophageal echocardiography performed after 6 months after patent foramen ovale closure demonstrating a right-to-left shunt (white arrow) around the posterior rim of the occluder device (white bracket).

Figure 4. Persistent Right-to-Left Shunt at 15-Month Follow-Up Still frame from contrast transesophageal echocardiography obtained 15 months after patent foramen ovale closure demonstrating a persistent right-to-left shunt at the posterior rim of the occluder.

Figure 5. Biplane Color Doppler TEE Demonstrating Right-to-Left Shunt Biplane transesophageal echocardiography color Doppler imaging demonstrating a right-to-left shunt at the posterior margin of the occluder (white circle).

Figure 6. Multiplanar and Three-Dimensional TEE Demonstrating the Erosion Tract Multiplanar and 3-dimensional transesophageal echocardiography demonstrating an irregular erosion tract adjacent to the occluder device. The complex and tortuous course of the erosion is confirmed by the curved trajectory of the coronary guidewire (white arrow), indicating nonlinear communication between the atria.

Figure 7. Three-Dimensional TEE Assessment for Secondary Device Closure Three-dimensional transesophageal echocardiography showing space (white circle) enough for deployment of another device at the back of the implanted occluder (black arrow).

Visual Summary. From PFO to Dual Occluders: Diagnostic Evaluation and Staged Transcatheter Management of a Residual Interatrial Shunt Caused by Device-Related Erosion After Initial PFO Closure cTEE = contrast transesophageal echocardiography; PFO = patent foramen ovale; TEE = transesophageal echocardiography.