Retrieval and repositioning of an embolized atrial septal defect closure device using a gooseneck snare

Abstract Background Closure of all haemodynamically significant atrial septal defects (ASDs) is recommended irrespective of symptoms. Percutaneous device closure offers a favourable alternative to surgery with lower morbidity, shorter duration of hospital stays, and avoidance of a surgical scar. Though device closure is generally a safe procedure with high success rates, certain complications can arise including device embolization which poses a significant challenge for the treating team. We report one such case in which the ASD closure device got spontaneously released and embolized from the delivery cable into the left atrium prior to its deployment. We describe our approach for its retrieval and subsequently its successful deployment across the septal defect using a gooseneck snare. Case presentation A 5-year-old asymptomatic child was found to have a murmur on a routine check-up. Evaluation revealed a haemodynamically significant, 18-mm ostium secundum ASD with normal pulmonary pressures and suitable margins for device closure. A 20-mm ASD closure device was traversed via an 8-Fr delivery system. While manipulating the left atrial (LA) disc from the right upper pulmonary vein (RUPV) approach, the device got spontaneously released. The right atrial (RA) disc was caught across the ASD, into the left atrium. This was confirmed by intraoperative transthoracic echocardiography and fluoroscopy. The haemodynamics and rhythm were stable. A 20-mm gooseneck snare was immediately passed through the delivery sheath and an attempt was made to catch the screw. With difficulty, the RA screw was caught with the snare and multiple attempts to retrieve the device into the sheath were unsuccessful. However, while negotiating, we were able to secure a favourable position of the device across the atrial septal defect, and after fluoroscopic and echocardiographic confirmation, the device was released. The child remained stable thereafter and was discharged 2 days later. Conclusions Gooseneck snare is a valuable tool in the management of embolized ASD closure device. Occasionally, like in the index case, one may be successful in retrieving the embolized device and repositioning it across the ASD using a gooseneck snare, thus obviating the need for emergency surgery.

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Closure of Secundum Atrial Septal Defect with Autologous Right Atrial Patch: Case Report

The Heart Surgery Forum ◽

10.1532/hsf98.20041173 ◽

2005 ◽

Vol 8 (2) ◽

pp. 96 ◽

Cited By ~ 1

Author(s):

Osman Tansel Dar�in ◽

Alper Sami Kunt ◽

Mehmet Halit Andac

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Complete Recovery ◽

Interatrial Septum ◽

Right Atrial ◽

Atrial Wall ◽

Residual Shunt ◽

Asd Closure ◽

The Right

Background: Although various synthetic materials and pericardium have been used for atrial septal defect (ASD) closure, investigators are continuing to search for an ideal material for this procedure. We report and evaluate a case in which autologous right atrial wall tissue was used for ASD closure. Case: In this case, we closed a secundum ASD of a 22-year-old woman who also had right atrial enlargement due to the defect. After establishing standard bicaval cannulation and total cardiopulmonary bypass, we opened the right atrium with an oblique incision in a superior position to a standard incision. After examining the secundum ASD, we created a flap on the inferior rim of the atrial wall. A stay suture was stitched between the tip of the flap and the superior rim of the defect, and suturing was continued in a clockwise direction thereafter. Considering the size and shape of the defect, we incised the inferior attachment of the flap, and suturing was completed. Remnants of the flap on the inferior rim were resected, and the right atrium was closed in a similar fashion. Results: During an echocardiographic examination, neither a residual shunt nor perigraft thrombosis was seen on the interatrial septum. The patient was discharged with complete recovery. Conclusion: Autologous right atrial patch is an ideal material for ASD closure, especially in patients having a large right atrium. A complete coaptation was achieved because of the muscular nature of the right atrial tissue and its thickness, which is a closer match to the atrial septum than other materials.

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Acute Changes in Left Ventricular End Diastolic Pressure following the Transcatheter Closure of an Atrial Septal Defect in Adults

The Heart Surgery Forum ◽

10.1532/hsf.1442 ◽

2016 ◽

Vol 19 (3) ◽

pp. 145 ◽

Cited By ~ 1

Author(s):

Young Hwa Kong ◽

Jinyoung Song ◽

Kyung Hee Kim ◽

June Huh ◽

I-Seok Kang

Keyword(s):

Elderly Patients ◽

Atrial Septal Defect ◽

Septal Defect ◽

Transcatheter Closure ◽

Diastolic Pressure ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Device Closure ◽

Acute Changes ◽

Asd Closure

Background: Acute changes in left ventricular diastolic function shortly after ASD closure in elderly patients have not been well known. We aimed to investigate acute changes in left ventricular end diastolic pressure (LVEDP) in elderly patients following transcatheter closure of atrial septal defect (ASD). Methods: All 19 adults with ASDs who underwent transcatheter closure between June 2013 and December 2014 were enrolled. LVEDP was measured prior to device closure and compared with that immediately following device closure and 15 minutes after device closure. Results: The median age of the patients was 48 years old. The baseline E/e’ and LVEDP values were 8.3 ± 2.8 and 13 ± 3 mmHg. The LVEDP value immediately following closure was 19 ± 4 mmHg, and 15 minutes after closure was 16 ± 4 mmHg. The median increase in the LVEDP value immediately following closure was 6 mmHg, which significantly differed from that prior to closure. The LVEDP 15 minutes after closure decreased but remained significantly higher than the value observed immediately after closure. No significant changes were observed with regard to E/e’ at either 1 day or 3 months following closure. The LVEDP value 15 minutes after device closure was significantly correlated with those observed before closure and immediately following closure; however, no significant correlations were observed with regard to patient age, Qp/Qs, E/e’ before closure, or E/e’ 3 months after device closure. Conclusion: LVEDP in adults with ASDs significantly increases following device closure. LVEDP before closure predicts LVEDP following device closure.

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Cobra head deformity of atrial septal occluder: blessing in disguise

Cardiology in the Young ◽

10.1017/s1047951120004084 ◽

2020 ◽

pp. 1-2

Author(s):

Uma Devi Karuru ◽

Saurabh Kumar Gupta

Keyword(s):

Atrial Septal Defect ◽

Left Atrial ◽

Septal Defect ◽

Atrial Septum ◽

Right Atrial ◽

Septal Occluder Device ◽

Occluder Device ◽

The Right

Abstract It is not uncommon to have prolapse of the atrial septal occluder device despite accurate measurement of atrial septal defect and an appropriately chosen device. This is particularly a problem in cases with large atrial septal defect with absent aortic rim. Various techniques have been described for successful implantation of atrial septal occluder in such a scenario. The essence of all these techniques is to prevent prolapse of the left atrial disc through the defect while the right atrial disc is being deployed. In this brief report, we illustrate the use of cobra head deformity of the device to successfully deploy the device across the atrial septum.

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P649 Before and after: sinus venosus atrial septal defect

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.331 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Marco Clement ◽

R Eiros ◽

R Dalmau ◽

T Lopez ◽

G Guzman ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Right Atrium ◽

Septal Defect ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

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Use of Mullins sheath to prevent prolapse of Gore Cardioform ASD Occluder in a child with severe scoliosis

Cardiology in the Young ◽

10.1017/s1047951120004242 ◽

2020 ◽

pp. 1-3

Author(s):

Christopher Herron ◽

Daisuke Kobayashi

Keyword(s):

Atrial Septal Defect ◽

Right Atrium ◽

Septal Defect ◽

Device Closure ◽

Severe Scoliosis ◽

The Right ◽

Transcatheter Device ◽

Delivery Catheter

Abstract Transcatheter device closure of an atrial septal defect (ASD) may require an additional supportive technique in challenging cases. We report a 15-year-old male with moderate-sized ASD and severe scoliosis. In spite of adequate positioning of the Gore Cardioform ASD occluder, the device was pulled into the right atrium by a retrieval cord due to the acute release of strong tension between the delivery catheter and its device upon locking. This phenomenon was prevented by the use of Mullins sheath, resulting in a successful release of the device. The use of a Mullins sheath may be considered to deliver a Gore Cardioform ASD device in selected cases.

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Cryoballoon Atrial Fibrillation Ablation in a Patient with an Atrial Septal Defect Closure Device

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v16i1.6602 ◽

2021 ◽

Author(s):

Meisam Mokhtari ◽

Zahra Khajali ◽

Mona Heidarali ◽

Majid Haghjoo

Keyword(s):

Atrial Fibrillation ◽

Atrial Septal Defect ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Septal Defect ◽

Closure Device ◽

Atrial Septal Defect Closure ◽

Occluder Device ◽

Asd Closure

Atrial fibrillation (AF) is the most commonly treated arrhythmia in clinical practice and is often found in association with an atrial septal defect (ASD). However, ASD closure rarely confers complete arrhythmia control. A 23-year-old man presented to our center with frequent episodes of palpitations. AF was documented in 12-lead electrocardiography, and echocardiography showed a secundum-type ASD, 14 mm in size, with a significant left-to-right shunt. ASD closure was performed successfully with an ASD occluder device with no residual shunting. During follow-up, the patient experienced several episodes of AF. Thirteen months after the ASD closure, cryoballoon pulmonary vein isolation was done successfully with no complications. During a 12-month follow-up, he had no symptoms or AF recurrences, and echocardiography showed no residual shunting. This study showed that cryoballoon pulmonary vein isolation could be performed successfully without residual shunts in patients with ASD closure devices.

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Experience of transcatheter device closure of atrial septal defect in a tertiary care institute

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1362 ◽

2021 ◽

pp. 1-12

Author(s):

Muhammad Younas ◽

Ahsan Beg ◽

Tauseef Asma ◽

Baqir Maqbool

Keyword(s):

Pericardial Effusion ◽

Atrial Septal Defect ◽

Septal Defect ◽

Tertiary Care ◽

Safe Procedure ◽

Device Closure ◽

Cross Sectional ◽

Female Ratio ◽

Transcatheter Device ◽

Small Pericardial Effusion

Abstract Objective: To share our experience of transcatheter device closure of secundum atrial septal defect in children and adults. Methods: This descriptive cross-sectional study was conducted at department of Paediatric Cardiology Ch. Pervaiz Elahi Institute of Cardiology Multan from 2011 to September 2019. Patients with moderate to large ASD secundum without severe pulmonary hypertension were studied. All procedures were performed under general anaesthesia and trans-Oesophageal echo guidance. Success and safety of procedure were evaluated. Results: During study period, a total of 75 patients underwent ASD device closure. Mean age was 25 ± 1.53 (4 -54 years) and male to female ratio 1:2. Mean defect was 20.38 ± 0.58 (09 to 32 mm). Large defects (> 25 mm) were 17 (22.7 %). Significant PS (> 30 mm Hg) observed in three and valvuloplasty performed. Device size was selected on the basis of TOE measurement + 4-5 mm. Balloon sizing was performed in only three patients. Amplatzer septal occluder was used in 80 %. Balloon assisted technique was used in 09 (12 %) patients. All the procedures were successful except two (2.7 %) where device embolized and retrieved by surgery. Transient arrhythmias were observed in 05 (6.6 %) and small pericardial effusion which was managed conservatively in one patient. There was no procedure related mortality. Conclusion: Transcatheter closure of moderate to large ASD secundum in children and adults is a safe procedure. Among the major events, device embolizaion was common. Other complications were rare including small pericardial effusion and transient arrhythmias. Continuous...

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P927Atrial fibrillation after atrial septal defect device closure - How to access the left atrium? A case series

EP Europace ◽

10.1093/ehjci/eux151.109 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii186-iii187

Author(s):

F. Bourier ◽

T. Reents ◽

M. Telishevska ◽

M. Kottmaier ◽

V. Semmler ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Septal Defect ◽

Case Series ◽

Device Closure

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Combined hybrid pulmonary valve placement and atrial septal defect closure: case report and literature review

Cardiology in the Young ◽

10.1017/s1047951120000724 ◽

2020 ◽

Vol 30 (5) ◽

pp. 737-739

Author(s):

Omar Abu-Anza ◽

Kaitlin Carr ◽

Osamah Aldoss

Keyword(s):

Atrial Septal Defect ◽

Septal Defect ◽

Pulmonary Valve ◽

Pulmonary Regurgitation ◽

Volume Overload ◽

Pulmonary Valve Replacement ◽

Device Closure ◽

Atrial Septal Defect Closure ◽

Valve Placement ◽

The Right

AbstractWe report a case of a 15-year-old female who underwent combined hybrid pulmonary valve replacement and transcatheter atrial septal defect device closure, which was performed due to severe volume overload of the right side of the heart secondary to pulmonary regurgitation and atrial septal defect.

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