If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Corresponding author: Dr Tomás F. Cianciulli, Department of Cardiology, Clínica Bazterrica, Juncal 3002 (A1425AYL), Capital Federal, Buenos Aires, Argentina. Tel./fax: +5411-4821-1600, ext. 129.
Department of Cardiology, Clínica Bazterrica, Buenos Aires, ArgentinaResearcher of the Ministry of Health, Government of the City of Buenos Aires, Buenos Aires, Argentina
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.
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.
, 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.
