Dear Editor, The figure-of-eight is a shadow artifact previously reported in echocardiography after left atrial appendage (LAA) closure with the Amplatzer Cardiac Plug and the newer Amplatzer Amulet Occluder (Abbott Laboratories, Abbott Park, Illinois, USA), as presented by Allam et al. in a previous volume of this journal.[1] Amplatzer devices consist of a self-expanding double disk made from nitinol epitrochoidal mesh wiring and polyester. Similar double-disc occluders are currently used for the endovascular treatment of diverse cardiac structural pathologies, including patent foramen ovale (PFO), atrial septal defects (ASDs), ventricular septal defects, and paravalvular leaks.[2,3] Here, we report the case of a figure-of-eight artifact seen in an outpatient clinic follow-up after successful PFO closure with an Amplatzer occluder device [Figure 1]. In the last years, transcatheter device closure has become the standard of care for PFO and select ASD closures, owing to their reduced comorbidity, shorter hospital stay, and lower risk profile compared with cardiac surgery.[4–6] Echocardiography plays an increasingly fundamental role in these patients' initial diagnosis, election of closure method, and subsequent follow-ups.[2,7] The Amplatzer Talisman PFO and the Amplatzer Septal Occluder are commonly used devices to correct such defects.[2,7] These septal occluders have flat right and curved left atrial discs, with the main distinctive feature between them being the diameter of the narrow central waist with differently sized right and left atrial discs in the PFO occluder and equivalent-sized discs in the septal occluder.[2]Figure 1: Figure-of-eight artifact as seen by the red arrows in (a) right ventricle long-axis view, (b) subcostal four-chamber view in two-dimensional, (c and d) and three-dimensional reconstruction. LA = left atrium, RV = right ventricle, LV = left ventricleThe formation of the figure-of-eight artifact is thought to be the result of the epitrochoidal configuration of the mesh wiring reflecting on ultrasound waves, with such configuration being universal to all mentioned occluder devices.[2,3]In vitro studies have successfully recreated the figure-of-eight artifact in the coronal position, regardless of the Amplatzer device variability, echocardiographic imaging depth, or axis angle.[2,3] This supports that it could be seen with other epitrochoidal occluders, including those used for PFO and ASD closure, as we show in our case. The presence of the figure-of-eight artifact, which can be seen both in transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), indicates an adequate intracardiac device position.[1,2,8] When visualizing LAA closure devices, the artifact is mainly seen in the apical five-chamber view with a smaller percentage on an off-axis three-chamber view. While for PFO and ASD closure devices, it is seen primarily in the right-ventricle long-axis and off-axis parasternal long-axis.[1–3,9] In our case, a right ventricle long-axis and subcostal four-chamber view allowed for the visualization of the figure-of-eight artifact while assessing for adequate device position with three-dimensional (3D) reconstruction [Figure 1]. 3D imaging is practical during intraprocedural implant TEE when using a coronal view which allows for the rounded visualization of the device.[9] It is important to note that due to imaging depth with a smaller probe-to-device distance seen with TEE, the figure-of-eight artifact can appear to be more asymmetrical than the one reproduced by TTE.[2] We suggest routinely reporting the figure-of-eight artifact in the echocardiographic follow-up of patients with Amplatzer devices as a finding that suggests adequate intracardiac device position. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.