J Cardiovasc Ultrasound.  2012 Dec;20(4):201-204. 10.4250/jcu.2012.20.4.201.

Subacute, Silent Embolization of Amplatzer Atrial Septal Defect Closure Device to the Pulmonary Artery

• Son JW
• Park JS

• KMID: 2177409
• DOI: http://doi.org/10.4250/jcu.2012.20.4.201

Abstract

Embolization of the closure device is a rare but potentially fatal complication of percutaneous atrial septal defect (ASD) closure. We report a case of 45-year-old woman who underwent ASD device closure with 32 mm Amplatzer device, which was embolized to the pulmonary artery without symptom one day after successful device implantation.

Keyword

Atrial septal defect; Septal occluder device; Embolization

MeSH Terms

Female
Heart Septal Defects, Atrial
Humans
Pulmonary Artery
Septal Occluder Device

Figure

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  Fig. 1 Large secundum atrial septal defect measuring 28 mm on transthoracic echocardiography (A). Transesophageal echocardiographic findings of sufficient superior and inferior vena caval rim (B) and preserved atrioventricular rim (C). Posterior rim was sufficient in length but relatively thin in nature, and aortic rim was nearly absent (D). RA: right atrium, LA: left atrium, IVC: inferior vena caval rim, SVC: superior vena caval rim, RV: right ventricle, AV: atrioventricular rim, SP: superoposterior rim, P: posterior rim, Ao: aortic rim.

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  Fig. 2 Intracardiac echocardiographic still image during procedure (A). The Amplatzer device was successfully deployed and its secure and stable position was confirmed by push-pull maneuver. Inferior vena caval rim (white arrow) and superior vena caval rim (white arrowhead) were captured and well positioned between left and right discs. Still frame of apical 4 chamber view by transthoracic echocardiography after procedure (B). Amplatzer occluder (white arrow) is well positioned in interatrial septum without residual shunt. RA: right atrium, LA: left atrium.

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  Fig. 3 One day after the procedure, the embolized Amplatzer device was seen in pulmonary artery (white arrow) on chest X-ray (A), which was lodged on right pulmonary artery ostium (white arrow) on transthoracic echocardiography (B). MPA: main pulmonary artery, RPA: right pulmonary artery, Ao: aorta.

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