J Korean Med Sci.  2015 Sep;30(9):1361-1366. 10.3346/jkms.2015.30.9.1361.

Percutaneous Retrieval of Embolized Amplatzer Septal Occluder after Treatment of Double Atrial Septal Defect: A Case Report

Affiliations
  • 1Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea. christiankyehun@hanmail.net
  • 2Department of Radiology, Chonnam National University Hospital, Gwangju, Korea.
  • 3Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Korea.

Abstract

Embolization of the occlusion device after percutaneous closure of atrial septal defect (ASD) is a potential disastrous complication. The usual site of embolization is the right side of the heart including pulmonary artery, but the device embolization to the extracardiac aorta is extremely rare. Here, we report a successful percutaneous retrieval case of the embolized Amplatzer Septal Occluder (ASO) to the descending thoracic aorta after the successful deployment of two ASO devices in a patient with double ASD. Competition between the two devices to obtain a stable position may be an explanation for the migration of ASO.

Keyword

Heart Septal Defects, Atrial; Septal Occluder Device; Device Removal

MeSH Terms

Adult
Device Removal/*methods
Embolism/*etiology/*surgery
Heart Septal Defects, Atrial/*complications/surgery
Humans
Male
Septal Occluder Device/*adverse effects
Treatment Outcome

Figure

  • Fig. 1 Transesophageal echocardiography revealed about 10.1 mm (antero-superior rim, long arrow) and 14.3 mm (postero-inferior rim, short arrow)-sized double atrial septal defects (ASD) (A) with shunt flow from left atrium to right atrium (B). After successful closure of ASD, two Amplatzer Septal Occluders (ASOs) were identified in superior (long arrow) and inferior rim (short arrow) of the interatrial septum (C) without residual defects (D). At third day, one of the two ASOs was not seen in the inferior defect (short arrow) due to device embolization and the other device in superior defect showed stable position (E). De novo left-to-right shunt developed between both atria (F).

  • Fig. 2 Transthoracic echocardiography revealed the embolized Amplatzed Septal Occluder (ASO) in the descending aorta on parasternal long (A) and modified short axis view (B). Chest computed tomographic angiography revealed one deployed ASO in interatrial septum and the other ASO in the descending thoracic aorta on axial (C) and sagital view (D). Arrow indicates embolized ASO and arrow head indicates deployed ASO in interatrial septum.

  • Fig. 3 (A) Aortogram revealed the embolized Amplatzed Septal Occluder (ASO) in the descending thoracic aorta (arrow head) and another ASO in the interatrial septum (arrow). After successful snaring of the screw on right atrial disc of ASO (B), ASO was successfully retrieved into the 10-french catheter (C, D).

  • Fig. 4 A proposed mechanism of the embolization of Amplatzer Septal Occluder (ASO). (A) Two ASO devices compete with each other along cardiac movement. (B) Counterforce between two devices results in dislocation and embolization of less stable ASO.


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