Abstract
The Amplatzer septal occluder device is used with high success and low-complication rate. Device embolization occurs in around 0.3–0.55% of cases. We report the case of a 44-year-old man with ventricular fibrillation (VF) due to embolization of Amplatzer septal occluder into the right ventricle, 1 h after the successful closure of secundum ASD with a 26-mm Amplatzer septal occluder device. The patient was immediately defibrillated. Bedside echocardiography revealed a free floating device in transit in the right chambers. Percutaneous retrieval attempt was unsuccessful. He was referred to surgery immediately. To our knowledge, VF has not been reported yet.
Transcatheter atrial septal defect (ASD) closure has been proven to be safe and effective and has become an increasingly used alternative to surgical closure of secundum-type ASD. The Amplatzer septal occluder device is the most commonly used device, and many reports have demonstrated that it has high success and low-complication rate . Device embolization occurs in around 0.3–0.55% of cases, independently from ASD size, device size, and physician’s experience . Percutaneously embolized device can be retrieved in about 50% of cases by several techniques .
We report the case of a 44-year-old man with ventricular fibrillation (VF) due to embolization of an Amplatzer septal occluder device into the right ventricle, 1 h after the successful closure of secundum ASD with a 26-mm Amplatzer septal occluder device ( Fig. 1 ) (intraoperative transeosephageal echocardiography measurement of ASD was 22 mm). The patient was immediately defibrillated. Bedside echocardiography revealed a free floating device in transit in the right chambers ( Fig. 2 ). We did not find any known secondary causes of VF. We believe that the possible reason for the triggering of VF was irritation of the tissue. Percutaneous retrieval attempt with a bioptome and a snare was unsuccessful. The device was immediately removed and ASD was surgically repaired. Although palpitation (including ventricular tachycardia) and syncope are the most common clinical presentation in device embolization, to our knowledge, VF has not been reported to date . This case underlines the importance of close monitoring for any unexpected complications, especially device embolization in the early period of the procedure.
