Incomplete Endothelialization of an Atrial Septal Occluder Suggested by Multimodality Imaging

Figures

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  Figure 1. Multimodality imaging and procedural assessment of an atrial septal occluder with constrained expansion and suspected incomplete endothelialization. (A–B) Transthoracic echocardiography: (a1) parasternal long-axis view showing a patent intra-device cavity (*) and abnormal device contour near the right lower pulmonary vein (white arrow); (a2) colour Doppler showing inflow into the cavity (yellow arrow); (b1) apical four-chamber view showing oscillation of an internal membrane (white arrow); and (b2) colour Doppler showing bidirectional intra-device flow (yellow arrow). (C–D) Transoesophageal echocardiography: (C) flow across the left atrial disc (white arrow); (d1) deformation of the left atrial disc (white arrow); and (d2) colour Doppler inflow at the deformed region (yellow arrow). (E–F) X-plane and three-dimensional transoesophageal echocardiography showing the patent intra-device cavity (*) and internal membranes (white and yellow arrows). (G) Computed tomography angiography showing partial embedding of the left atrial disc within the right lower pulmonary vein ostium (yellow arrow), constrained expansion, device-associated thrombus (white arrow), and contrast pooling (*). (H)…