Retrieval of embolized Amplatzer septal occluder using ablation catheter and triple-loop snare
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CASE REPORT
Retrieval of embolized Amplatzer septal occluder using ablation catheter and triple-loop snare Akio Kawamura • Nobuhiro Nishiyama Takashi Kawakami • Keiichi Fukuda
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Received: 19 September 2013 / Accepted: 13 December 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
Abstract Percutaneous closure of atrial septal defect has been accepted as an effective and safe treatment. So far, there has been no procedure-related mortality in Japan. However, device embolization is one of the major complications related to the procedure. We report successful retrieval of an Amplatzer septal occluder embolized and impacted in the pulmonary artery using an ablation catheter and a triple-loop snare device.
Introduction Transcatheter ASD closure has rapidly become the standard treatment of secundum ASD. One of the major complications of this procedure is the device embolization, which can occur in about 0.5–1.1 % of cases even done by experienced hands [1, 2]. Percutaneous retrieval of an embolized Amplatzer septal occluder is not always easy, with success rate of 50–70 % [2]. Snaring the knob on the right atrial disk is the key point for successful percutaneous retrieval. However, it can be challenging depending on the orientation of the occluder and often needs to rotate the device before snaring. We describe here successful retrieval of an Amplatzer septal occluder embolized and stuck in the pulmonary artery with combined use of an ablation catheter and a triple-loop snare device.
A. Kawamura (&) N. Nishiyama T. Kawakami K. Fukuda Department of Cardiovascular Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan e-mail: [email protected]
Case A 63-year-old gentleman with pulmonary fibrosis was referred for percutaneous closure of a secundum ASD. The patient presented with progressive worsening of dyspnea on exertion. Transthoracic and transesophageal echocardiography (TEE) showed significant left-to-right shunt (the pulmonary-to-systemic flow ratio of 2.1) with right ventricular volume overload. All the rims around the ASD were adequate for device closure. The patient underwent percutaneous ASD closure with an Amplatzer septal occluder (ASO) (St. Jude Medical, St. Paul, MN, USA) under intracardiac echocardiography (ICE) guidance. The defect diameter was 20 mm both by TEE and by ICE. Using a 24-mm Amplatzer sizing balloon (AGA Medical, North Plymouth MN, USA), the stop flow diameter was 25.0 mm. We delivered a 24-mm ASO onto the septum. We detached the device after confirming the device position by ICE and fluoroscopy. In retrospect, the superior rim was not fully sandwiched by the device. The patient was free of symptoms overnight and no arrhythmia was noted on ECG monitor. On the next morning, routine chest X-ray revealed that the device was embolized into the pulmonary artery. After discussion with the patient and surgeons, we decided to remove the device percutaneously because surgical removal was considered to be high
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