Urgent surgical management for embolized occluder devices in childhood: single center experience

Abstract

BackgroundIn this study, we sought to analyze our experience in urgent surgical management for embolized cardiac septal and ductal occluder devices resulting from trans-catheter closure of atrial septal defect, ventricular septal defect and patent ductus arteriosus in childhood patient group.MethodsWe retrospectively reviewed 9 patients (aged 2–15 years) who underwent urgent surgery due to cardiac septal and ductal occluder embolization between January 2007 and December 2010. Congenital defects were atrial septal defect (n = 6), ventricular septal defect (n = 1), and patent ductus arteriosus (n = 2). Risk factors for device embolization and urgent surgical management techniques for embolized device removal were discussed.ResultsRemoval of embolized devices in all cases and repair of damaged tricuspid valve in 2 patients were performed. Inevitably, all congenital defects were closed or ligated up to the primary defect. Total circulator arrest necessitated in 1 patient with ascending aortic device embolization. All operations were completed successfully and no hospital mortality or morbidity was encountered.ConclusionsAlthough closure of left to right shunting defects by percutaneous occluder devices has a lot of advantages, device embolization is still a major complication. If embolized device retrieval fails with percutaneous intervention attempts, surgical management is the only method to remove embolized devices. In this circumstance, to provide an uneventful perioperative course, urgent management strategies should be well planned.

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.…”

Surgical retrieval of embolized patent ductus arteriosus occluder device in an adult after 12 years of initial deployment: A case report with perioperative considerations and decision-making in resource-limited settings

“…[ 4 ] PA wall tissue was suspected to be friable due to long-standing embedment of the device into the wall of the artery. [ 4 9 ] Therefore, we decided to retrieve the device on CPB for meticulous repair of the PA.…”

Hybrid approach for aortic embolization of Amplatzer duct occluder

“…When device is embolized into PA and the percutaneous retrieval fails, usually requires median sternotomy PDA ligation and device retrieval with or without cardio pulmonary bypass (CPB). [ 5 ] However, failure of percutaneous retrieval in aortic embolization of the device necessitates sternotomy with CPB and deep hypothermic circulatory arrest (DHCA)[ 5 ] for arch embolization, aortotomy and retrieval[ 6 ] for DTA embolization and abdominal exploration[ 7 ] for infradiaphragmatic aorta or its branch embolization.…”