PMC3959059_01
Two-dimensional transthoracic echocardiogram in apical four-chamber view showing a 27 mm atrial septal defect (horizontal arrow) and stenotic mitral valve (vertical arrow)
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F1
Transthoracic echocardiography (TTE) showed a 27 mm ostium secundum ASD with severe rheumatic MS [Figure 1].
Inoue balloon positioned in the left ventricular cavity over the Inoue wire before mitral valvuloplasty
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F2
With Inoue balloon stabilized in the LV cavity, the ESW was changed to Inoue wire for better conformation to the LV anatomy and provide safe support to Inoue balloon during mitral valvotomy [Figure 2].
Transesophageal echocardiography showing malpositioned Amplatzer device into the right atrial cavity
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F3
ASD. Twelve hours postprocedure TTE showed a malpositioned device, which was confirmed later on transesophageal echocardiography (TEE) [Figure 3]. After arranging for full surgical backup, percutaneous retrieval of malpositioned ASD device was undertaken under cinefluroscopic and TEE guidance.
Percutaneous retrieval of malpositioned atrial septal defect (ASD) device under cinefluroscopic and transesophageal echocardiography (TEE) guidance. (a) The right atrial disk microscrew mechanism being snared with a 1-cm Amplatz GooseNeck snare. (b) The device being pulled into the 12 French Amplatzer sheath with intentional bevel at the end. (c) Successful retrieval of the device from the right atrium into the inferior vena cava (causing the device to elongate) below the kidneys and through the femoral sheath.
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F4
USA) was chosen with intention to grasp the microscrew of the right atrial disk of the ASD device. Using alternate orthogonal views to align the snare in the plane of the ASD device, the device was successfully pulled from the RA into the inferior vena cava below the kidneys and retrieved through the femoral sheath [Figure 4a-c].
Lateral projection showing successful final deployment of a 36 mm Heartr  atrial septal occluder device
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F5
Final ASD device closure [Figure 5] was done with a 36 mm Heartr  atrial septal occluder device (Lifetech Scientific Inc., Shenzhen, China).