PMC6010619_01
a (left) and b. Fig. 1a is a mid-esophageal view at 115  and demonstrates left to right flow during diastole through the intra-atrial shunt. Fig. 1b: This color M-mode is displayed across the intra-atrial septum and shows bi-directionality dependent upon cardiac cycle. Red arrows indicate the septum secundum. Green arrows indicate septum primum.
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A transesophageal echocardiogram was performed and revealed a large intra-atrial (Fig. 1a) bidirectional shunt with right-to-left flow during systole and left-to-right flow during diastole (Fig. 1b).
Continuous wave Doppler demonstrates dense diastolic flow with rapid deceleration consistent with fast equilibration of the right ventricle and pulmonary artery and to-and-fro flow through the pulmonary valve consistent with severe pulmonary regurgitation. Blue double arrow is systolic forward flow and orange arrow is diastolic regurgitant flow.
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Severe pulmonary regurgitation was demonstrated on Doppler assessment (Fig. 2).
2D and 3D TEE images showing ASD closure device in place before migration.
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Furthermore, the thick septum primum and thin septum secundum support this over an atrial septal defect (Fig. 3). Day four after admission, he was taken to the cardiac catheterization laboratory, where a 30 mm CardioSeal patent foramen ovale closure device was placed. (Fig. 3).
a: Arterial sagital and b: arterial coronal MIP view demonstrating ASD closure device within the abdominal aorta.
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On ICU day fifteen, follow-up CT scans revealed persistence of left cerebellar vermis infarct, improved interstitial edema of the lung and migration of the CardioSeal device to the abdominal aorta at the level of the celiac trunk and SMA (Fig. 4).