Transcatheter Retrieval of Embolized Atrial Septal Defect Occluder Device by Waist Capture Technique

Abstract

SummaryThis case study describes the successful percutaneous transcatheter retrieval of an embolized Amplatzer occluder device using the "waist capture technique" in a patient with an atrial septal defect. This technique allowed for stability of the Amplatzer device, compression of the atrial discs for easier removal, prevention of further embolization, and minimal injury to vasculature during device retrieval. This novel and effective technique can be used safely for the retrieval of Amplatzer devices in the venous system.(Int Heart J 2018; 59: 226-228) Key words: Amplatzer occlusion device, Percutaneous transcatheter occlusion T he percutaneous transcatheter occlusion technique is an effective, successful alternative to surgery for the treatment of atrial septal defects (ASD). The Amplatzer septal occlusion device is efficient, safe, and easy to use and has a high success rate.1,2) However, a common complication occurring in 0.55% of cases is device embolization.3) Transcatheter retrieval of the embolized device is possible in about half of cases, and several techniques have been described, including the use of gooseneck snares, pig tail catheters, and bioptomes. [3][4][5] In this case study, we report the successful transcatheter retrieval of an embolized ASD occluder device using the "waist capture technique." Case ReportA 51-year-old man presented with dyspnea on exertion (NYHA class II), with physical examination revealing a split second heart sound and a left sternal systolic murmur. Electrocardiography showed incomplete right bundle branch block. Transthoracic echocardiography (TTE) showed a secundum type ASD with a left to right shunt and a moderate pulmonary/systemic flow ratio (Qp/Qs) of 2.2 and transesophageal echocardiography (TEE) confirmed the presence of a round shaped ASD, measuring 20 mm by 18 mm. The aortic rim was the shortest measuring 2 mm, while all other surrounding rims had adequate margins. Preparation was made for percutaneous ASD closure with the patient's informed consent. The procedure was performed under general anesthesia with TEE guidance. The stretched maximal diameter of the defect with sizing balloon was 22 mm, and a 22 mm Amplatzer septal occluder device was selected for use.The device was loaded into the delivery system and introduced into a 9-French long sheath that had already been placed over the exchange wire. After the device was advanced into the left atrium (LA), the delivery system was withdrawn into the right atrium (RA) until the LA sided disc opened and aligned with the interatrial septum. When continuous TEE confirmed adequate device positioning, the RA sided disc was opened, and to assure stability and appropriate apposition to the rims, gentle push/pull (The Minnesota Wiggle) was performed prior to releasing the device. In view of the complete obliteration of color flow across the defect on TEE as well as the stable position of the device, it was left in place.The next day, routine chest x-rays and TTE were performed. The x-rays revealed the Amplatzer device sh...

A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil

“…Next, we searched the literature and found that it is similar to loop snares and other advanced techniques. 4,5,15) Compared with previously reported techniques, our technique has more advantages. Firstly, the loop snare technique reported by Lisa, et al 16) used a 16-F sheath to remove the filter tip.…”

“…There are a wide variety of techniques which have been used to remove filters that could not be retrieved by conventional methods. [4][5][6][7][8] Among them, one of the most efficient and simplest ways is the loop snare technique. We further modified this method to make it easier to retrieve the filters.…”

Initial experiences with a novel biodegradable device for percutaneous closure of atrial septal defects: From preclinical study to first‐in‐human experience

“…Based on our experience in vitro, it was harder to retrieve a device in the “locked state” into a same size delivery sheath, as compared to that in the “unlocked state.” Therefore, we suggest the use of a sheath larger than the initial delivery sheath to retrieve the embolized device. Moreover, since the marks on the device enable the identification of the position of the waist and the tip of the left disc, the “Waist Capture Technique” with a looped wire or a snare to capture the waist of the device might be feasible for device retrieval.…”

Aortik Arka Embolize Olan Atriyal Septal Defekt Okluder Cihazının Hibrit Çıkartılma İşlemi: Çiviyi Çiviyle Sökme

“…Cihazın biopsi kateterleri yada Amplatz GooseNeck® Snare( Abbott Medical, USA) ile geri alınması söz konusu olsa da başarısız olunmasında cerrahi güvenli bir seçenektir. Hatta, Her et al (11). da venöz sisteme embolize olan cihazın farklı bir teknik olarak cihazın bel kısmında yakalanarak çıkarılmasını sunmuşlardır.…”