The “Peanut Sign” is a useful tool to detect spiral atrial septal defects

Spiral atrial septal defects may complicate transcatheter closure and increase the risk of device embolisation. We describe a 5-year-old boy with pulmonary stenosis and a secundum atrial septal defect in whom an initially implanted 9 mm device embolised. At repeat intervention, balloon sizing revealed a bilobed, peanut-shaped configuration with a double waist, suggestive of a spiral atrial septal defect. A 15 mm device was subsequently implanted, achieving stable closure. The "Peanut Sign" may serve as a useful marker for identifying spiral atrial septal defects and guiding appropriate device selection.