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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Published online: November 22, 2013
Accepted: November 15, 2013
Received: November 7, 2013
See page 465.e3 for disclosure information.
© 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.