Akademik Veri Yönetim Sistemi
TKD 40. Ulusal Kardiyoloji Kongresi, Antalya, Türkiye, 7 - 10 Kasım 2024, cilt.1, ss.131, (Özet Bildiri)
Introduction: Material embolization during percutaneous ASD closure procedures is rare but increasingly observed due to the rise in such interventions. This situation may be associated with increased morbidity and mortality rates. Various techniques can be applied to remove embolized materials. Case Presentation: In this case, the retrieval of a fractured sheath during a percutaneous ASD closure procedure is presented. A 22-year-old female patient presented to the outpatient clinic with exertional dyspnea. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction (LVEF) of 60%, mild mitral regurgitation, mild tricuspid regurgitation, and interatrial septal passage observed with color Doppler. Subsequent transesophageal echocardiography (TOE) identified a 15 mm secundum-type ASD with a QP/QS ratio of 2.0. The patient was presented to the joint KVC-Cardiology council, and a decision for percutaneous ASD closure was made. After right femoral vein puncture, a stiff wire was advanced into the left upper pulmonary vein through an 8F sheath using a multipurpose catheter. Upon advancing the sizing balloon through the sheath, it was observed that the sheath had fractured and was located near the right atrium, obstructing the balloon’s expansion. The sheath fragment was pulled back to the iliac veins using the stiff wire. Upon further resistance, a floppy guide wire (fgw) was introduced through the sheath. A 3.0*15 mm balloon was then advanced over the fgw, inflated, and the entire system was maneuvered and retracted. The fractured sheath tip was subsequently externalized through a new right femoral sheath. A new puncture was performed, and a 16 mm Amplatzer septal occluder was deployed in the secundum ASD region. It was released after confirming its position using the Minnesota maneuver. The procedure was successfully completed, and the patient was discharged in good health. At the 1-month follow-up, echocardiography showed an LVEF of 60% with minimal passage at the septal occluder site observed with color Doppler. The patient was asymptomatic during follow-up. Conclusion: When materials used during percutaneous interventions embolize, the primary rule is to perform maneuvers that cause the least harm to the patient. The appropriate technique should be determined based on the patient’s clinical condition, the operator’s clinical experience, and the variety of equipment available in the catheter laboratory