Presentation
History of VSD s/p repair presenting with fever. Chest radiograph performed for evaluation of pneumonia.
Patient Data
1. Two disc-shaped radio-opaque structures with two radio-opaque dots can be visualized in the cardiac silhouette in the region of the ventricular septum (seen best in AP scoliosis study, images #3 and #4), consistent with a VSD occlusion device. Additionally, there are multiple small sternotomy sutures and surgical clips in the left perihilar region.
2. Mild cardiomegaly with suggestion of right ventricular hypertrophy. No pulmonary vascular congestion.
3. Stable mild levoconvex upper thoracic scoliosis, hypoplastic right 1st rib and partial fusion anomaly of the left 4th and 5th ribs are stable.
4. Mild bilateral peribronchial thickening. No discrete focal pneumonia, pleural effusion or pneumothorax.
5. The upper abdomen appears normal.
Case Discussion
Closure of ventricular septal defects (VSDs) is typically indicated for hemodynamically significant shunts, aortic regurgitation, and history of infective endocarditis. Options for closure include surgical repair and transcatheter VSD closure, which has become increasingly common though is presently only recommended for uncomplicated, muscular VSDs and select membranous VSDs.
Modern Amplatzer VSD occlusion devices are made of nitinol and have a double disc appearance with a central waist connection, which sits in the defect in the interventricular septum. These discs can be symmetric or asymmetric depending on the model, and some have radiopaque markers to confirm positioning, like those seen in our patient. Other devices used for closure, some off-label, include nitinol or vascular coils, duct occluders, double umbrella devices, buttoned devices, and Starflex devices.
Disclosure: I, Hilary Bowman, 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.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
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