Silent embolization of an Amplatzer septal occluder into the left ventricular outflow tract requiring emergent surgical retrieval

Abstract

Percutaneous closure of secundum atrial septal defect is an established safe alternative to surgery with rare complications and high primary success rate. This procedure can be complicated by early or late device embolizations. We report an asymptomatic delayed nonobstructive embolization of an amplatzer septal occluder (ASO) into the left ventricle outflow tract detected by routine transthoracic echocardiography 1 week after implantation, which required emergent surgical retrieval in a stable patient.

Management of a large atrial septal occluder embolized to the left ventricular outflow tract without the use of cardiac surgery

“…Successful percutaneous retrieval of embolized ASO devices has been infrequently reported . Despite this, the vast majority of cases with LV embolized devices were retrieved surgically . In our case, the position of the embolized ASO was favorable for retrograde percutaneous retrieval as it was located in the LVOT.…”

“…Most ASO embolization occur during the initial implantation procedure . Depending on the site of embolization, the clinical manifestation may vary from being totally asymptomatic to incessant ventricular tachyarrhythmias . In our case, the patient experienced palpitations from ventricular ectopy, which alerted the medical team to the possibility of a delayed device embolization into the ventricle .…”

Surgical management of embolized Amplatzer septal occluder into the left ventricle tangled with the mitral valve

“…Management of ASO embolizations has been previously described in the literature as single case reports and very few multicenter experiences have been reported. 1,2,[4][5][6][7] Embolization sites can be the right atrium, right ventricle, pulmonary valve, tricuspid valve, and F I G U R E 1 A, Transthoracic echocardiography showing Amplatzer atrial septal occluder tangled with mitral anterior leaflet chordal apparatus. B, Cath-lab fluoroscopy of percutaneous retrieval attempt procedure, with the left atrial appendage occluder implanted and the dislodged atrial septal occluder snared through its waist by means of a loop F I G U R E 2 A, Left ventricular inferior dissecting hematoma.…”

“…In these cases, when the percutaneous retrieval of the device fails, surgical removal is needed. 4 We report a rare case of symptomatic embolization of an ASO into the left ventricular outflow tract The publication of the case report was approved by the local ethics committee.…”

Spontaneous embolization of an atrial septal defect occluder device into the left ventricular outflow tract in a patient with pulmonary stenosis

“…In normal condition, due to the pressure difference between right and left ventricular chambers, the embolization of the device is expected through to right heart . In this patient, due to the increased right heart pressures because of existing pulmonary stenosis and the inadequate visualization of device malposition by TTE maybe the reasons of embolization of device to the left ventricle . To avoid such complication, it is essential to ensure about the size of suitable device by measurement of defect with balloon sizing method and TEE, and final assessment of the position of the devices should be performed by TEE.…”