Complications in atrial septal defect device closure

Abstract

Atrial septal defect (ASD) is a common congenital cardiac anomaly. Even though surgery is the gold standard, percutaneous device closure is gaining popularity because of the short learning curve, cosmetic advantage and relative safety. The long-term implications are open to question. We report here two cases where surgical intervention was required during attempted percutaneous closure and briefly review the relevant literature.

Transcatheter device closure of atrial septal defects in patients aged 40 years and older

“…22 The percutaneous approach for ASD closure in elderly patients may have reduced periprocedural morbidity and mortality compared with surgical approach. 16,23 However, during follow-up two cases of device embolisation without clear acute clinical symptoms and one case of not well positioned device have been recorded warranting for surgical intervention. Literature indicates that malposition and embolisation are indeed the commonest reasons for surgical reintervention.…”

Radiology of cardiac devices and their complications

“…Complications associated with the placement of closure devices include vascular trauma, cardiac perforation, device malposition, thrombus formation with resultant distal embolization, residual shunts, arrhythmias and infective endocarditis. 88 Both short-term and long-term complications can sometimes be appreciated on imaging examinations, including chest radiography. 89 In addition, left atrial appendage closure is now routinely performed as a prophylactic procedure for the prevention of thromboembolic disease in certain clinical settings, such as in patients with atrial fibrillation who have contraindications to anticoagulation therapy.…”

Embolization of Atrial Septal Defect Occluder Device into the Left Ventricle- Emergency Surgical Removal

“…The patient had an uneventful recovery and was discharged a week later. 4 Embolization does not commonly occur but if develops, the reasons are insufficient rim around the defect, early release of device, and mismatch between the size of ASD and Amplatzer which is due to the use of small Amplatzer for a large ASD. Transesophageal echocardiography (TEE) performed during Amplatzer placement seems to be a potential contributor to prevent technical errors and occurrence of complications.…”