Canadian Journal of Cardiology 30 (2014) 465.e3e465.e4 www.onlinecjc.ca
Images in Cardiology
Surgical Rescue of Embolized Amplatzer Septal Occluder Tomás Francisco Cianciulli, MD, FACC,a,b Hector Jorge Redruello, MD,a Miguel Angel Rubio, MD,c Ricardo Luis Poveda Camargo, MD,c Miguel Angel Granja, MD,a Carlos Manuel Barrero, MD, FACC,a and Víctor Miguel Mauro, MDa a b
Department of Cardiology, Clínica Bazterrica, Buenos Aires, Argentina
Researcher of the Ministry of Health, Government of the City of Buenos Aires, Buenos Aires, Argentina c
Department of Cardiovascular Surgery, Clínica Bazterrica, Buenos Aires, Argentina
A 66-year-old man underwent transcatheter closure of a secundum atrial septal defect (ASD) with an Amplatzer septal occluder (ASO). Transesophageal echocardiography showed a 19-mm secundum ASD with adequate rims all around. The defect was balloon sized and the stretched diameter was 21.5 mm. A 22-mm ASO was successfully delivered. The patient was discharged after transthoracic echocardiography showed the ASO at the middle of the atrial septum. On routine follow-up examination 4 weeks after implantation, the patient was asymptomatic. Surprisingly, transthoracic echocardiography showed an ASD with a significant left-to-right shunt and the embolized device dislodged and vertically trapped in the left ventricular inflow tract without any
, view video obstruction (Fig. 1, A and B; Videos 1 and 2 online). Percutaneous retrieval of the device was not attempted because of its position of difficult access between the chordae tendineae of the mitral valve. The patient was referred for surgical removal of the device (Fig. 1, C and D). The mitral valve, leaflets, and chordae were carefully examined for traumatic injury, and no abnormal findings were noted. The postoperative course was uneventful. The ASD device closure can be associated with failure; thus, close monitoring and facilities for safe percutaneous or surgical emergency removal should be available for all patients.
Received for publication November 7, 2013. Accepted November 15, 2013.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2013.11.018.
Corresponding author: Dr Tomás F. Cianciulli, Department of Cardiology, Clínica Bazterrica, Juncal 3002 (A1425AYL), Capital Federal, Buenos Aires, Argentina. Tel./fax: þ5411-4821-1600, ext. 129. E-mail: [email protected] See page 465.e3 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.11.018
465.e4
Canadian Journal of Cardiology Volume 30 2014
Figure 1. (A) Two-dimensional transthoracic echocardiography. Parasternal long axis view, showing the atrial septal occluder (ASO) dislodged in the left ventricular inflow tract (arrow). (B) Colour flow Doppler. Subcostal 4-chamber view demonstrating left-to-right shunting through the atrial septal defect (ASD) and the ASO trapped in the left ventricular inflow tract (arrow). (C) Operative view of surgical device (arrow) removal. (D) Amplatzer septal occluder removed. Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
Images in Cardiology
Surgical Rescue of Embolized Amplatzer Septal Occluder Tomás Francisco Cianciulli, MD, FACC,a,b Hector Jorge Redruello, MD,a Miguel Angel Rubio, MD,c Ricardo Luis Poveda Camargo, MD,c Miguel Angel Granja, MD,a Carlos Manuel Barrero, MD, FACC,a and Víctor Miguel Mauro, MDa a b
Department of Cardiology, Clínica Bazterrica, Buenos Aires, Argentina
Researcher of the Ministry of Health, Government of the City of Buenos Aires, Buenos Aires, Argentina c
Department of Cardiovascular Surgery, Clínica Bazterrica, Buenos Aires, Argentina
A 66-year-old man underwent transcatheter closure of a secundum atrial septal defect (ASD) with an Amplatzer septal occluder (ASO). Transesophageal echocardiography showed a 19-mm secundum ASD with adequate rims all around. The defect was balloon sized and the stretched diameter was 21.5 mm. A 22-mm ASO was successfully delivered. The patient was discharged after transthoracic echocardiography showed the ASO at the middle of the atrial septum. On routine follow-up examination 4 weeks after implantation, the patient was asymptomatic. Surprisingly, transthoracic echocardiography showed an ASD with a significant left-to-right shunt and the embolized device dislodged and vertically trapped in the left ventricular inflow tract without any
, view video obstruction (Fig. 1, A and B; Videos 1 and 2 online). Percutaneous retrieval of the device was not attempted because of its position of difficult access between the chordae tendineae of the mitral valve. The patient was referred for surgical removal of the device (Fig. 1, C and D). The mitral valve, leaflets, and chordae were carefully examined for traumatic injury, and no abnormal findings were noted. The postoperative course was uneventful. The ASD device closure can be associated with failure; thus, close monitoring and facilities for safe percutaneous or surgical emergency removal should be available for all patients.
Received for publication November 7, 2013. Accepted November 15, 2013.
Supplementary Material To access the supplementary material accompanying this article, visit the online version of the Canadian Journal of Cardiology at www.onlinecjc.ca and at http://dx.doi.org/10. 1016/j.cjca.2013.11.018.
Corresponding author: Dr Tomás F. Cianciulli, Department of Cardiology, Clínica Bazterrica, Juncal 3002 (A1425AYL), Capital Federal, Buenos Aires, Argentina. Tel./fax: þ5411-4821-1600, ext. 129. E-mail: [email protected] See page 465.e3 for disclosure information.
Disclosures The authors have no conflicts of interest to disclose.
0828-282X/$ - see front matter Ó 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.cjca.2013.11.018
465.e4
Canadian Journal of Cardiology Volume 30 2014
Figure 1. (A) Two-dimensional transthoracic echocardiography. Parasternal long axis view, showing the atrial septal occluder (ASO) dislodged in the left ventricular inflow tract (arrow). (B) Colour flow Doppler. Subcostal 4-chamber view demonstrating left-to-right shunting through the atrial septal defect (ASD) and the ASO trapped in the left ventricular inflow tract (arrow). (C) Operative view of surgical device (arrow) removal. (D) Amplatzer septal occluder removed. Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
