Author + information
- Received September 22, 2008
- Revision received October 10, 2008
- Accepted November 3, 2008
- Published online March 10, 2009.
A 58-year-old woman with no significant past medical history was referred with a 2-year history of shortness of breath on exertion. Her electrocardiogram demonstrated atrial fibrillation with a normal axis and QRS complexes. A transthoracic echocardiogram demonstrated normal left-sided measurements but right-sided enlargement. A transesophageal contrast study was performed with agitated saline injection (A to C, Online Videos 1and 2). This demonstrated a 1-cm secundum atrial septal defect. The patient was referred for catheter-based device closure of the lesion.
Panel Ashows a pre-contrast image with an atrial septal defect (arrow). Panel Bshows that after injection of contrast, the right atrium (RA) has become opacified. “Negative contrast” is seen secondary to contrast-free blood shunting from the left atrium (LA) into the RA through the septal defect (arrow). Panel Cshows that after injection of contrast and a Valsalva maneuver, the contrast refluxes into the LA, demonstrating reversal of the shunt (arrow).
- Received September 22, 2008.
- Revision received October 10, 2008.
- Accepted November 3, 2008.
- American College of Cardiology Foundation