A 25-year-old woman presented to our echocardiography laboratory for a follow-up imaging study. She had a history of muscular ventricular septal defect (VSD) closure by Amplatzer Muscular VSD Occluder (St. Jude Medical, USA) 4 years before this visit. Since this repair, she has remained asymptomatic and was on no medication. In transthoracic echocardiography, the double disc device was visualized in apical four-chamber view (Fig. 1) with no residual VSD flow. Interestingly, in off-axis view of parasternal long-axis imaging, the device was visualized in the form of two side-by-side figure of 8 “Clover-leaf” appearances (Figs. 2 and 3).

Figure 1/Video 1 Apical four-chamber echocardiogram showing normal biventricular function. The double-disc occluder device is visualized in the mid part of the interventricular septum. 

Figure 2/Video 2 Off-axis parasternal long-axis view showing the figure of 8 image artifact of the occluder device. 

Figure 3/Video 3 The occluder device resembles a clover-leaf in this off-axis parasternal long-axis view. 

Percutaneous disc occluders due to their specific “epitrochoidal” mesh configuration and the interaction with ultrasound waves; form this image artifact when viewed from a coronal imaging position¹. Transthoracic echocardiography is the main method of follow-up for post-procedural device position, and accurate interpretation of views is of utmost importance².

By increasing utilization of percutaneous closure devices for various indications including atrial and VSD, left atrial appendage, patent foramen ovale, recognition of this particular pattern as a normal imaging artifact of a deployed double-disc device when visualized from a coronal imaging position is necessary to avoid misinterpretations of studies such as malposition or displaced device.