PMC6458657_01
Aortogram sequence shows (a) the deployment of the Amplatzer Septal Occluder, (b) the migration of the ASO in the left atrium, (c) the migration of the ASO in the left ventricle, (d) the embolization of the ASO in the thoracic aorta and (e) the embolization of the ASO into the abdominal aorta that is occluded below the level of renal arteries.
10.1177_2050313X19842462-fig1.jpg
PMC6458657_01_10.1177_2050313X19842462-fig1.jpg
fig1-2050313X19842462
A Caucasian woman was referred to us, in emergency, from other Institution, because the interventional cardiologists, attempting a transcatheter closure of ASD, observed, few minutes after the device deployment, the migration of a 28.5/28.5 mm ASO into the infrarenal abdominal aorta (Figure 1(a)-(e)).
PMC6458657_02
Aortogram shows (a) a 0.035 guidewire passing through the nitinol mesh of the Amplatzer Septal Occluder (black arrow), (b) a 0.035 buddy wire (black arrow) passing between the inner lumen of the aorta and ASO, (c) the 24 F sheath (black arrow) including both guidewires just below the ASO, (d) the introduction of 6 F goose-neck snare (black arrow) and (e) the goose-neck snaring the guidewire (black arrow) previously passed through the ASO.
10.1177_2050313X19842462-fig2.jpg
PMC6458657_02_10.1177_2050313X19842462-fig2.jpg
fig2-2050313X19842462
The guidewire in the right femoral artery was replaced with a 5 F, 100-cm long, pigtail catheter (Super Torque, Cordis, Johnson-Johnson, Ireland), and an angiography was performed confirming abdominal aorta occlusion below the level of the renal arteries; through this pigtail, a 0.035-in angled, 260 cm long, guidewire (Terumo, Leuven, Belgium, Europe) was introduced and passed through the nitinol wire mesh of the occluder (Figure 2(a)). ASO occluder and the inner lumen of the aorta, above the renal arteries up to the aortic valve plane (Figure 2(b)); the pigtail and the 11 F sheath were replaced with a 24 F sheath (33 cm) Dryseal Flex (Gore, USA), including both guidewires, that was placed just below the vascular plug (Figure 2(c)). A 6 F goose-neck Snare Merit Medical of 35 mm (Utah, USA) was advanced along the guidewire previously positioned (Figure 2(d)); therefore, this guidewire was withdrawn and the goose-neck advanced permitting to snare the guidewire passing through the ASO mesh (Figure 2(e)).
Aortogram shows (a) the ASO device slenderized into the 24 F sheath (black arrow) and (b) complete retrieval of the device (black arrow).
10.1177_2050313X19842462-fig3.jpg
PMC6458657_02_10.1177_2050313X19842462-fig3.jpg
fig3-2050313X19842462
The entire device was slenderized and pulled into the large 24 F sheath and successfully retrieved (Figures 3 and 4).
Gross specimen shows (a) the 24 F sheath including the ASO device (black arrow) and (b) the guidewire passing through the mesh of the device out of the large sheath (black arrow).
10.1177_2050313X19842462-fig4.jpg
PMC6458657_02_10.1177_2050313X19842462-fig4.jpg
fig4-2050313X19842462
The entire device was slenderized and pulled into the large 24 F sheath and successfully retrieved (Figures 3 and 4).
PMC6458657_03