J Korean Med Sci.  2014 Jun;29(6):871-873. 10.3346/jkms.2014.29.6.871.

Percutaneous Retrieval and Redeployment of an Atrial Septal Occluder under Three-Dimensional Transesophageal Echocardiographic Guidance: A Case Report

• Ahn J
• Kim JH
• Choi JH
• Oh JH

• KMID: 1796953
• DOI: http://doi.org/10.3346/jkms.2014.29.6.871

Abstract

Percutaneous device closure for secundum atrial septal defects (ASDs) has been performed commonly and safely with high success rates. However, it is still challenging to close ASDs that are surrounded with deficient or hypermobile rims and could be compromised with an unexpected migration of device. We report a case of percutaneous Amplazter Septal Occluder (ASO; St. Jude Medical Inc., St. Paul, Minnesota, USA) device closure for an ASD with a thin and floppy interatrial septum, which immediately migrated into the right atrium and was not pulled back into the delivery sheath. To our knowledge, this is the first report on a successful percutaneous retrieval and redeployment of the device in such a situation, preventing any vascular injury or unplanned emergency open heart surgery.

Keyword

Atrial Septal Occluder; Migration; Retrieval; Percutaneous

MeSH Terms

Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Female
Fluoroscopy
Heart Atria/ultrasonography
Heart Septal Defects, Atrial/*therapy
Humans
Middle Aged
*Septal Occluder Device

Figure

• 

  Fig. 1 Echocardiographic findings. (A) 3D multi-planar reconstruction (MPR) view showed inferior and superior vena cava (SVC) rims. (B) While aortic rim was almost absent, posterior rim seemed to be sufficient but was thin and floopy. (C) On the view from right atrium (RA), an oval-shaped, secundum-type atrial septal defect (*) was shown in this 3D MPR image. (D) Just after device deployment, 3D transesophageal echocardiography (TEE) showed the oblique settlement of the device with its superior portion slipping into the RA. (E) Remnant shunt flow at the side of SVC rim was noted in color doppler image. (F) The successfully closed defect with the device was shown in this 3D-TEE image. IVC, inferior vena cava; SVC, superior vena cava; LA, left atrium; RA, right atrium; ASO, Amplater Septal Occluder.

• 

  Fig. 2 Fluoroscopic findings during procedure. (A) The GooseNeck snare captured the screw on the right atrial side of the device. (B) After femoral sheath change into the larger one, the device was jammed into the sheath and was removed. (C) Subsequently, the same device was deployed successfully. TEE, transesophageal echocardiography; ASO, Amplatzer Septal Occluder.

Reference

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