Successful retrieval of migrated Amplatzer septal occluder

Abstract

Migration and embolization of the Amplatzer septal occluder (ASO) have been reported. However, there is only limited information on the methods of systematic retrieval of these devices. In this report, we describe the a case of a 4 year old girl who underwent closure of her atrial septal defect (ASD) using a 17 mm ASO. The device migrated in to the right atrium an anteroposterior plane 24 hours later with a resultant residual shunt. The device was successfully retrieved percutaneously and the ASD was closed using a 20 mm ASO.

Successful retrieval of a Figulla Occlutech septal occluder - embolized device stability and potential solutions

“…The reported options to stabilize device include a bioptome, a stiff guide wire and a pigtail catheter. [ 11 12 13 ] As there is no left atrial hub on Occlutech device, it did not cross our mind that we could still hold the device by a bioptome from neck approach. This, however, was a good alternative approach, which could avoid pulling a bare device into the IVC.…”

“…[ 1 2 3 4 5 ] Device embolization may occur (0.4-0.6%) and in experienced hands, successful percutaneous retrieval is reported in up to 70% of the cases. [ 5 6 7 8 9 10 11 12 13 ] With the availability of multiple closure devices, the techniques of retrieval need to be modified as per device construction. We describe a case of device embolization of Figulla Occlutech device, which was retrieved successfully from the right ventricle.…”

A novel snare assistance safeguards against early embolization of devices and facilitates quick retrieval of malpositioned devices in atrial septal defects with deficient margins

“…However, this needs long fluoroscopic time and prolongs radiation exposure to the patients and healthcare personnel in the catheterization laboratory. [ 11 12 13 ] Prior holding of the screw end permits very quick retrieval of a malpositioned or embolized device, as the delivery sheath was intentionally chosen larger than the recommended size. In these high-risk patients at risk of embolization, choosing a larger sheath facilitates an easy retrieval.…”

Atrial Septal Defect: Step-by-Step Catheter Closure

“…Device embolization: -Rare complication (0.55%) [24] -Usually occurs in those with large ASD and deficient rims. Can embolize to either side of the atrial septum (left frame: ASO embolized to the right ventricle; Video 46) -Majority do not cause acute hemodynamic collapse -Most can be snared and retrieved percutaneously (right frame: ASO being retrieved from the descending thoracic aorta; Video 47); principles of percutaneous device retrieval have been well described in the literature [25] Slide # 68:…”