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Evaluation of a Large Atrial Septal Occluder with Cardiac MR Imaging¹

¹ From the Departments of Medical Imaging (C.L., R.G.) and Cardiology (M.J.R., J.M., N.D.), Hôpital Sainte-Justine, University of Montreal, 3175 Côte-Sainte-Catherine Road, Montreal, Quebec, Canada H3T 1C5. Presented as a scientific poster at the 2002 RSNA scientific assembly. Received February 13, 2003; revision requested April 22 and received June 17; accepted July 7. Address correspondence to C.L. (e-mail: chantal_lapierre@ssss.gouv.qc.ca).

View larger version (187K): [in a new window]   Figure 1.  Photograph of the Amplatzer ASO. The device consists of two saucer-shaped disks made of self-expanding nitinol mesh and connected by a central cylinder that resembles a stent-graft.

View larger version (133K): [in a new window]   Figure 2.  The percentage of protrusion was calculated from the ratio of the extent of disk protrusion (solid arrows) to the total diameter of the adjacent structure (in this case, the superior vena cava) (open arrows).

View larger version (144K): [in a new window]   Figure 3a.  Coronal oblique 2D cine MR images of the right superior pulmonary vein. (a) Image obtained with the left atrium (straight black arrow) at maximal volume shows that the left disk of the ASO (curved black arrow) does not protrude into the vein (white arrow). (b) Image obtained with the left atrium (straight black arrow) at minimal volume shows protrusion of the disk (curved black arrow) into the vein (white arrow).

View larger version (140K): [in a new window]   Figure 3b.  Coronal oblique 2D cine MR images of the right superior pulmonary vein. (a) Image obtained with the left atrium (straight black arrow) at maximal volume shows that the left disk of the ASO (curved black arrow) does not protrude into the vein (white arrow). (b) Image obtained with the left atrium (straight black arrow) at minimal volume shows protrusion of the disk (curved black arrow) into the vein (white arrow).

View larger version (126K): [in a new window]   Figure 4a.  Axial oblique 2D cine MR images of the right inferior pulmonary vein. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows that the left disk of the ASO (black arrow) does not protrude into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (128K): [in a new window]   Figure 4b.  Axial oblique 2D cine MR images of the right inferior pulmonary vein. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows that the left disk of the ASO (black arrow) does not protrude into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (143K): [in a new window]   Figure 5a.  Sagittal oblique 2D cine MR images of the right superior vena cava. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows that the right disk of the ASO (black arrow) does not protrude into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (142K): [in a new window]   Figure 5b.  Sagittal oblique 2D cine MR images of the right superior vena cava. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows that the right disk of the ASO (black arrow) does not protrude into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (129K): [in a new window]   Figure 6a.  Sagittal oblique 2D cine MR images of the inferior vena cava. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows the greatest protrusion of the right disk of the ASO (black arrow) into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows less protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (130K): [in a new window]   Figure 6b.  Sagittal oblique 2D cine MR images of the inferior vena cava. (a) Image obtained with the left atrium (straight white arrow) at maximal volume shows the greatest protrusion of the right disk of the ASO (black arrow) into the vein (curved white arrow). (b) Image obtained with the left atrium (straight white arrow) at minimal volume shows less protrusion of the disk (black arrow) into the vein (curved white arrow).

View larger version (129K): [in a new window]   Figure 7.  Axial oblique 2D cine MR image shows absence of contact between the left disk of the ASO (curved arrow) and the mitral valve (straight arrow).

View larger version (137K): [in a new window]   Figure 8.  Axial oblique 2D cine MR image shows contact between the ASO (curved arrow) and the annulus of the mitral valve (straight arrow).

View larger version (28K): [in a new window]   Figure 9.  Diagram of the extent of deformation in patients in whom contact occurred between the ASO and the aortic valve and root. LA = left atrium.

View larger version (119K): [in a new window]   Figure 10.  Axial oblique 2D cine MR image shows extrinsic contact between the ASO (curved arrow) and the aortic valve (straight arrow) and root, without consequent deformation.

View larger version (126K): [in a new window]   Figure 11.  Axial oblique 2D cine MR image shows extrinsic contact between the left disk of the ASO (curved arrow) and the aortic valve (straight arrow) and root, with consequent deformation.

View larger version (141K): [in a new window]   Figure 12.  Axial oblique 2D cine MR image shows extrinsic contact between both disks of the ASO (curved arrow) and the aortic valve (straight arrow) and root, with consequent deformation.

View larger version (136K): [in a new window]   Figure 13a.  (a) Axial oblique 2D cine MR image obtained during ventricular systole shows displacement of the right disk (curved arrow) in the right atrium and an increased distance between the disks (straight arrow). (b) Axial oblique 2D cine MR image obtained during ventricular diastole shows less distance between the disks (straight arrow). Curved arrow = right disk.

View larger version (137K): [in a new window]   Figure 13b.  (a) Axial oblique 2D cine MR image obtained during ventricular systole shows displacement of the right disk (curved arrow) in the right atrium and an increased distance between the disks (straight arrow). (b) Axial oblique 2D cine MR image obtained during ventricular diastole shows less distance between the disks (straight arrow). Curved arrow = right disk.