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

• Cho JY
• Kim KH
• Yoon HJ
• Seon HJ
• Ahn Y
• Jeong MH
• Cho JG
• Park JC

• KMID: 2344165
• DOI: http://doi.org/10.3346/jkms.2015.30.9.1361

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.

Reference

1. Hopkins RA, Bert AA, Buchholz B, Guarino K, Meyers M. Surgical patch closure of atrial septal defects. Ann Thorac Surg. 2004; 77:2144–2149. author reply 9-50

2. King TD, Thompson SL, Steiner C, Mills NL. Secundum atrial septal defect. Nonoperative closure during cardiac catheterization. JAMA. 1976; 235:2506–2509.

3. Du ZD, Hijazi ZM, Kleinman CS, Silverman NH, Larntz K. Amplatzer Investigators. Comparison between transcatheter and surgical closure of secundum atrial septal defect in children and adults: results of a multicenter nonrandomized trial. J Am Coll Cardiol. 2002; 39:1836–1844.

4. Pedra CA, Fontes-Pedra SR, Esteves CA, Assef J, Fontes VF, Hijazi ZM. Multiple atrial septal defects and patent ductus arteriosus: successful outcome using two Amplatzer septal occluders and Gianturco coils. Cathet Cardiovasc Diagn. 1998; 45:257–259.

5. Cao Q, Radtke W, Berger F, Zhu W, Hijazi ZM. Transcatheter closure of multiple atrial septal defects. Initial results and value of two- and three-dimensional transoesophageal echocardiography. Eur Heart J. 2000; 21:941–947.

6. Berger F, Vogel M, Alexi-Meskishvili V, Lange PE. Comparison of results and complications of surgical and Amplatzer device closure of atrial septal defects. J Thorac Cardiovasc Surg. 1999; 118:674–678. discussion 8-80

7. Krumsdorf U, Ostermayer S, Billinger K, Trepels T, Zadan E, Horvath K, Sievert H. Incidence and clinical course of thrombus formation on atrial septal defect and patient foramen ovale closure devices in 1,000 consecutive patients. J Am Coll Cardiol. 2004; 43:302–309.

8. Moore J, Hegde S, El-Said H, Beekman R 3rd, Benson L, Bergersen L, Holzer R, Jenkins K, Ringel R, Rome J, et al. Transcatheter device closure of atrial septal defects: a safety review. JACC Cardiovasc Interv. 2013; 6:433–442.

9. Levi DS, Moore JW. Embolization and retrieval of the Amplatzer septal occluder. Catheter Cardiovasc Interv. 2004; 61:543–547.

10. Amanullah MM, Siddiqui MT, Khan MZ, Atiq MA. Surgical rescue of embolized amplatzer devices. J Card Surg. 2011; 26:254–258.

11. Son JW, Park JS. Subacute, silent embolization of amplatzer atrial septal defect closure device to the pulmonary artery. J Cardiovasc Ultrasound. 2012; 20:201–204.

12. Mashman WE, King SB, Jacobs WC, Ballard WL. Two cases of late embolization of Amplatzer septal occluder devices to the pulmonary artery following closure of secundum atrial septal defects. Catheter Cardiovasc Interv. 2005; 65:588–592.

13. Chan KT, Cheng BC. Retrieval of an embolized amplatzer septal occluder. Catheter Cardiovasc Interv. 2010; 75:465–468.

14. Pala S, Açar G, Tigen K, Kirma C. Percutaneous retrieval of an interatrial septal occluder device embolized into the aortic arch. Turk Kardiyol Dern Ars. 2010; 38:502–504.

15. Guimaraes M, Denton CE, Uflacker R, Schonholz C, Selby B Jr, Hannegan C. Percutaneous retrieval of an Amplatzer septal occluder device that had migrated to the aortic arch. Cardiovasc Intervent Radiol. 2012; 35:430–433.

16. Misra M, Sadiq A, Namboodiri N, Karunakaran J. The 'aortic rim' recount: embolization of interatrial septal occluder into the main pulmonary artery bifurcation after atrial septal defect closure. Interact Cardiovasc Thorac Surg. 2007; 6:384–386.

17. Mehta S, Hill JA, Qureshi AM, Latson LA, Prieto LR. Helex device closure of multiple atrial septal defects. Catheter Cardiovasc Interv. 2014; 84:204–210.

18. Song ZY, He GX, Shu MQ, Hu HY, Tong SF, Ran BL, Liu JP, Li YH, Jing T. Clinical efficiency and safety analysis of transcatheter closure of multiple atrial septal defects in adults. Clin Cardiol. 2009; 32:130–134.