Emergent surgical removal of a migrated atrial septal defect occluder: case report
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(2020) 15:327
CASE REPORT
Open Access
Emergent surgical removal of a migrated atrial septal defect occluder: case report Bi Wen and Juan He*
Abstract Background: Atrial septal defect (ASD) closure has been widely accepted and is now routinely performed using a percutaneous approach under especially echocardiographic guidance Transesophageal echocardiography (TEE). One major complication is dislocation of occluder device during or after the device implantation. Surgical removal may be required, especially when the device stuck in the left ventricular outflow tract (LVOT). Case introduction: A 21-year-old female was admitted to our department for percutaneous closure of secundum ASD. Percutaneous closure under the guidance of TEE was recommended for the patients. During device implantation, the TEE showed dislocation of the 22 mm ASD occluder device, stucked into the LVOT and behind the anterior mitral leaflet, producing severe LVOT obstruction Fig. 1). We herein present a safe and quick technique for surgical removal of an ASD occlude device located in the LVOT. Conclusion: This technique provides a safe method for surgical removal of malposition and migration ASD occluder device. Keywords: Surgical retrieval, ASD closure device, Left ventricular outflow tract
Background Atrial septal defect (ASD) is one of the most common congenital anomalies. Percutaneous closure of secundum ASD has evolved over the past three decades, and is considered a standard treatment for ASD in recent years [1]. Although infrequent, complications such as arrhythmia, embolization, thrombosis, dislocation of occluder device and perforation have been reported associated with this procedure [2]. The occluder device be retrieved percutaneously sometimes, however surgical removal may be needed, especially when the device stuck in the LVOT and left atrial disk towards the ASD. It is difficult to remove the device without damage to the chordae and mitral valve. We present a safe and quick technique for surgical removal of ASD closure device stuck in the LVOT behind the anterior mitral leaflet. * Correspondence: [email protected] Department of Cardiology, West China Hospital, Sichuan University, Guoxuexiang 37th, 610041 Chengdu, Sichuan, P.R. China
Case report A 21-year-old female was admitted to our department for percutaneous closure of secundum ASD because of progressive decrease in exercise tolerance. Transthoracic echocardiography (TTE) revealed a 16 mm secundum ASD with adequate rims, the posterior rim, superior rim, inferior rim were 10 mm, 12 mm, 16 mm respectively. Left to right shunt and moderate right-sided heart enlargement were also proved by TTE. Percutaneous closure under the guidance of TEE with 22 mm ASD occluder device was recommended for the patients. During device implantation, the TEE showed dislocation of the 22 mm ASD occluder device (Shanghai Shape Memory Alloy, China), stucked into the LVOT and behind the anterior mitral leaflet, producing severe LVOT obstruction (Fig. 1, videos 1 and 2). Emergent surgical removal of t
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