Canadian Journal of Cardiology
Images in Cardiology| Volume 30, ISSUE 4, P465.e3-465.e4, April 2014

Surgical Rescue of Embolized Amplatzer Septal Occluder

Published:November 22, 2013DOI:
      A 66-year-old man underwent transcatheter closure of a secundum atrial septal defect (ASD) with an Amplatzer septal occluder (ASO). Transesophageal echocardiography showed a 19-mm secundum ASD with adequate rims all around. The defect was balloon sized and the stretched diameter was 21.5 mm. A 22-mm ASO was successfully delivered. The patient was discharged after transthoracic echocardiography showed the ASO at the middle of the atrial septum. On routine follow-up examination 4 weeks after implantation, the patient was asymptomatic. Surprisingly, transthoracic echocardiography showed an ASD with a significant left-to-right shunt and the embolized device dislodged and vertically trapped in the left ventricular inflow tract without any obstruction (Fig. 1, A and B; Videos 1 and 2 , view video online). Percutaneous retrieval of the device was not attempted because of its position of difficult access between the chordae tendineae of the mitral valve. The patient was referred for surgical removal of the device (Fig. 1, C and D). The mitral valve, leaflets, and chordae were carefully examined for traumatic injury, and no abnormal findings were noted. The postoperative course was uneventful. The ASD device closure can be associated with failure; thus, close monitoring and facilities for safe percutaneous or surgical emergency removal should be available for all patients.
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      Figure 1(A) Two-dimensional transthoracic echocardiography. Parasternal long axis view, showing the atrial septal occluder (ASO) dislodged in the left ventricular inflow tract (arrow). (B) Colour flow Doppler. Subcostal 4-chamber view demonstrating left-to-right shunting through the atrial septal defect (ASD) and the ASO trapped in the left ventricular inflow tract (arrow). (C) Operative view of surgical device (arrow) removal. (D) Amplatzer septal occluder removed. Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
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