Embolization of an Amplatzer Atrial Septal Closure Device to the Pulmonary Artery

Abstract

A 44-year-old woman with a history of transient ischemic attack underwent closure of atrial septal defect with a 26 mm Amplatzer device. The device was released without residual shunt or impingement on intracardiac structures. Within seconds, the transesophageal echocardiography showed the initial dislodgement of the device from the atrial septum and its consequent slipping back into the right atrium close to the tricuspid valve. Soon after the device disappeared from the right atrium and it could be founded into the right ventricle under the tricuspid valve. The patient was transferred in the operating room for an emergency operation. The device could not be found in the right ventricle because its downstream migration. The Amplatzer septal occluder was identified by palpation into the pulmonary artery trunk: it was retrieved from the right ventricle through the pulmonary valve and the atrial septal defect was closed by running suture.

Retrieval of the Atrial Septal Defect Closure Device Embolized to Pulmonary Artery

“…İmplantasyon sonrasında cihazın hareketli olması ve aortik rimin 5 mm'den dar olması da erken ve geç embolizasyon riskini artırmaktadır (5) . Perkütan ASD kapatma cihazları intrakardiyak olarak sağ ya da sol atriyuma veya sağ ventriküle embolize olabildiği gibi sistemik dolaşıma geçerek arkus aorta ya da abdominal aorta da embolize olabilmektedirler (1,6) . Ancak cihaz embolizasyonun en sık gerçekleştiği yer ana pulmoner arterdir (4) .…”

“…Kawamura ve arkadaşları cerrahinin yük-sek risk taşıdığı bir olguda pulmoner artere embolize olan cihazın perkütan yöntemle ablasyon kateteri ve üçlü sner kullanarak çıkartıldığını bildirmişlerdir (7) . Ancak cihazın perkütan tekniklerle çıkartılması esnasında kalp kapaklarının ya da subvalvüler yapıların zarar görmesi riski mevcuttur ve olguların çoğunda tercih edilen yöntem açık cerrahidir (1) . Cerrahi yaklaşım ASD'nin perkütan kapatma girişimi için uygun olmadığı olgularda hem cihazın çıkartılmasına hem de defektin kapatılmasına imkan vermektedir.…”

A Silent and Late Embolization of Atrial Septal Defect Occluder Device Into the Right Pulmonary Artery: A Case Report

“…However, percutaneous device closure is associated with rare early and late complications such as migration or embolization of the device, pericardial effusion, arrhythmias, thrombus formation on the device, and mitral regurgitation and vascular injury 4)7)8). The most frequent complication of percutaneous transcatheter closure of ASD is device embolization with incidence ranging from 4% to 21% 9). Embolization usually occurs within 24 hours and after that, it is rarely seen.…”

Unusual Embolization of Atrial Septal Defect Device in Left Ventricle and its Successful Retrieval

“…6 The surgical or percutaneous interventional methods may be used in the retrieval of the embolized devices. 7 Since the device was in the left ventricle, surgical treatment was implemented and successful results were achieved. The surgical approach makes possible to both retrieve the device and close the defect in case ASD is not suitable for percutaneous closure intervention.…”