Akademik Veri Yönetim Sistemi
41. ULUSAL KARDİYOLOJİ KONGRESİ, Antalya, Türkiye, 13 - 16 Kasım 2025, ss.20-21, (Özet Bildiri)
Introduction: Secundum type atrial septal defect is one of the most common congenital heart defects that occur in adults. In the past, closure was performed surgically, but now percutaneous closure is a good alternative. However, some complications may still occur, such as device embolization, air embolism, cardiac tamponade and residual shunts. We report a complication of device embolization of the ASD occluder device into the pulmonary artery. Case: A 50-year-old woman presented with dyspnea. Routine blood tests and a transthoracic echocardiogram were planned. A transesophageal echocardiogram was performed to check for a potential shunt across the interatrial septum. A secundum-type atrial septal defect of 1.4 cm was discovered by transesophageal echocardiography (Figure 1). The Qp/Qs ratio was 1.6 and right ventricle was mildly dilated. The patient was presented at the cardiology heart team meeting, and percutaneous closure of the ASD was recommended. An attempt was made to implant a 17 mm occluder device under TEE guidance. Transthoracic echocardiographic guidance was used to continue the procedure because the patient was unable to swallow the TEE probe. Using the Minnesota maneuver, the 17 mm Amplatzer occluder was deployed at the planned location; however, follow-up fluoroscopy revealed that the device had migrated into the pulmonary artery. To retrieve the device, a snare was advanced to the right atrial screw end of the cable, and the three interlaced loops were tightened around the screw on the right atrial disc (Figure 2). After several attempts, the screw mechanism was successfully snared, and the device was carefully pulled out through the femoral vein. The patient, who developed respiratory distress, was intubated. The TEE probe was advanced using a video laryngoscope, and the procedure was continued under TEE guidance. Balloon sizing was repeated, and based on a measured ASD diameter of 17 mm, a 19 mm Amplatzer occluder device was selected. A 19 mm ASD occluder device was deployed under fluoroscopic and transesophageal echocardiographic guidance. Before releasing the device, its position was also confirmed using fluoroscopy and the Minnesota maneuver (Figure 3). After no shunt was observed, the procedure was terminated. With the help of the anesthesia team, the patient was extubated and transferred to the intensive care unit for monitoring. Discussion: This case shows the successful management of an ASD occluder device that migrated into the pulmonary artery. The device was removed using a snare, avoiding the need for surgery. Quickly recognizing and retrieving a migrated device is important to prevent hemodynamic problems. Careful planning, choosing the right device, and using imaging tools such as TEE and fluoroscopy help reduce complications. Keywords: Amplatzer occluder, Atrial septal defect, Device migration, Percutaneous cosure, Pulmonary artery