Successful percutaneous retrieval of a dislodged left atrial appendage occlusion device with double transseptal sheaths and biopsy bioptome

Abstract

A 64-year-old woman underwent left atrial appendage occlusion with an Amplatzer Cardiac Plug device. Displacement of the device was detected on day 1 with transesophageal echocardiographic checking. The device became dislodged and flitted in the left atrium after unsuccessful retrieval with a snare and 12 Fr steerable transseptal sheath. A double transseptal sheath technique was then attempted. The flitting device was stabilized by one 12 Fr steerable transseptal sheath and successfully retrieved with a biopsy bioptome through another similar transseptal sheath. The patient suffered from no long-term sequelae.

Embolization of left atrial appendage closure devices: A systematic review of cases reported with the watchman device and the amplatzer cardiac plug

“…Potential causal mechanisms for embolization were reported in only four cases including device undersizing in two cases , device oversizing in one case , and conversion from AF to sinus rhythm in another case . Major adverse events related to device embolization occurred in three patients (9.7%): one case of internal bleeding during percutaneous retrieval, one case of device‐related Ao cusps damage requiring Ao valve replacement and 1 case of death due to cardiogenic shock.…”

“…Finally, a total of 20 studies reporting 31 cases of device embolization were identified including 2 multi‐center randomized trials, 4 multi‐center registries, 6 single‐center registries and 9 case reports. There were 13 reported cases with WM and 18 cases with ACP . Studies reporting embolization of WM and ACP are summarized in Table .…”

“…Following transseptal puncture, the authors used a double snare technique with first a 30‐mm snare to wrap and stabilize the dislodged ACP and a second snare for grabbing the device with successful device retraction into a 24‐Fr steerable sheath usually used for mitral valve clipping procedure . In another report of acute ACP dislodgement into the LA cavity, the authors used a double transseptal sheath technique . The floating device was first stabilized by one 12F steerable transseptal sheath and successfully retrieved with a biopsy bioptome through another similar transseptal sheath.…”

Percutaneous Retrieval of Dislodged Left Atrial Appendage Occlusion Devices through the Transseptal Approach

“…6 In another case, an acutely dislodged ACP device in the LA was percutaneously retrieved with double transseptal sheaths and a biopsy bioptome. 7 The most difficult aspect of percutaneous retrieval of a migrated device is stabilizing the device flitting in the LA cavity and aligning its distal screw with the retrieval tool. As described in our first case, we used a steerable ablation catheter to stabilize the moving ACP device against the LA wall and a U-shaped 6-Fr EBU catheter to achieve good alignment between the distal screw of the ACP device and a gooseneck snare loop.…”

The Amplatzer Vascular Plug: Review of Evolution and Current Applications

“…Migrated devices can be removed by engaging one of the short tips with a snare or by engaging the mesh itself using biopsy forceps, and then collapsing the plug inside a larger sheath for removal. 14,15 Endothelialization of the migrated device can make the retrieval very difficult and potentially traumatic. 16…”