Migration of an Atrial Septal Occluder Device to the Transverse Aortic Arch Detected with Echocardiography

Abstract

Atrial septal defects (ASDs) are one of the most common heart defects diagnosed in the adult population. If left unrepaired, they may lead to significant complications including right heart volume overload, pulmonary complications, and heart failure. Percutaneous transcatheter closure by use of an occluder device is clinically indicated for most patients with a secundum ASD and who are symptomatic. Although this procedure is safe, in rare instances, complications may be encountered, including atrial wall perforation, arrhythmias, and, in very rare instances, device migration. Echocardiography has become a widely used and reliable form of patient imaging that relies on the skillset of the sonographer as well as the interpreting physician. This case study illustrates the specific role of the cardiac sonographer in taking a careful clinical history, imaging of an ASD occluder device, and its location as it migrated into the aortic arch. This case also demonstrates the importance of imaging beyond the standard echocardiographic protocol, given this clinical manifestation.