Can patients with atrial septal defect (ASD) closures undergo high-resolution computed tomography (CT) chest scans or magnetic resonance imaging (MRI)?

Can Patients with ASD Closures Undergo CT or MRI?

Yes, patients with atrial septal defect closure devices can safely undergo both high-resolution CT chest scans and MRI—in fact, these imaging modalities are specifically rated as "Appropriate" for post-closure surveillance and evaluation. 1

Safety and Feasibility of Advanced Imaging Post-ASD Closure

CT Imaging After ASD Closure

• CT is superior to MRI for evaluating metallic closure devices and is not limited by implanted cardiac devices 1
• CT provides excellent visualization of the closure device without significant artifacts that would limit cardiac chamber assessment 1
• CT is specifically rated "Appropriate" for assessment of atrial septal anatomy in both preprocedural and postprocedural evaluation 1
• Modern low-dose CT protocols can achieve effective doses equal to or lower than 1 mSv for many congenital heart disease indications 1

MRI Imaging After ASD Closure

• Cardiac MRI is rated "Appropriate" for evaluation when clinical status changes or new concerning symptoms develop after ASD closure 1, 2
• MRI accurately quantifies shunt magnitude and assesses ventricular volumes without radiation exposure 2
• MRI is specifically rated "Appropriate" for assessment of atrial septal anatomy in preprocedural evaluation and this extends to postprocedural assessment 1, 3
• While MRI is more susceptible to metallic artifacts than CT, stents and closure devices are not contraindications to CMR 1

Clinical Algorithm for Imaging Selection Post-ASD Closure

When to Use CT:

• Evaluation of device position, integrity, and patency (CT is superior for metallic device assessment) 1
• Assessment of pulmonary venous anatomy, particularly after sinus venosus ASD or PAPVC repair 1
• When detailed visualization of calcifications within vessels is needed 1
• Patients with implanted cardiac devices where MRI may be relatively contraindicated 1

When to Use MRI:

• Quantification of ventricular volumes and function when serial measurements are needed without radiation exposure 1, 2
• Assessment of residual shunt magnitude 2
• Evaluation of myocardial tissue characteristics 1
• Younger patients where minimizing radiation exposure is paramount 1

Surveillance Imaging Recommendations

Routine Follow-Up in Uncomplicated Cases:

• Transthoracic echocardiography (TTE) is the primary modality for routine surveillance at 1 week, 1 month, 3-6 months, 1 year, and every 2-5 years thereafter 1, 2, 4
• CT or MRI are reserved for specific indications rather than routine surveillance 1

When Advanced Imaging (CT/MRI) is Indicated:

• Evaluation for device migration, erosion, or other complications at 3 months to 1 year post-closure and periodically thereafter 1, 2
• Significant residual shunt with RV volume overload requiring quantification 1, 2
• Systemic or pulmonary venous obstruction 1
• Inadequate echocardiographic windows or inconclusive TTE findings 1

Critical Pitfalls to Avoid

• Do not assume closure devices are MRI contraindications—they are MRI-conditional and imaging can be safely performed 1
• CT provides superior device visualization compared to MRI due to less metallic artifact, so choose CT when device integrity is the primary concern 1
• For patients requiring serial imaging, balance radiation exposure from CT against diagnostic yield—consider MRI for younger patients needing repeated assessments 1
• Both modalities require iodinated contrast (CT) or gadolinium-based contrast agents (MRI), so assess renal function and contraindications before ordering 1
• Device erosion is rare but life-threatening—new chest pain or syncope requires urgent evaluation with immediate echocardiography, potentially followed by CT for definitive assessment 2, 4