PMC2921526_01
Transesophageal echo in the short axis view of the aorta (a) showing a large secundum atrial septal defect (b) Successful closure of the defect using 17 mm Amplatzer septal occluder (c) Migration of the device 24 hours later at the aortic end in the anteroposterior plane. The migrated device was successfully retrieved percutaneously, (d) Successful deployment of the 20 mm Amplatzer septal occluder
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TEE confirmed the presence of a moderately large secundum ASD [Figure 1a] measuring 14 mm and having adequate rims all around, except the aortic rim, which was deficient. TEE [Figure 1b] and fluoroscopy [Figure 2a and b] after the final release. TTE , as a part of a routine protocol. The device had moved from its previous position [Figure 1c] with a residual shunt seen superior and anterior to the device. This was confirmed on fluoroscopy [Figure 2c]. Hence, a 20 mm ASO was used and the device was successfully deployed [Figure 1d], using the balloon-assisted technique.
Fluroscopic images immediately after deployment, showing the normal position of the device (a) in left anterior oblique projection with cranial angulation and (b) posteroanterior projection. Fluroscopic image 24 hours later showing (c) migrated device (d) held by a bioptome from the right jugular vein and a snare from the right femoral vein (e) Right atrial disk being pulled into the 10F sheath, with left atrial disk still held by the bioptome. (f) Bioptome is opened to release the left atrial disk. (g) The left atrial disk being pulled into the sheath. (h) The entire device is slenderized and brought into the sheath
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TEE [Figure 1b] and fluoroscopy [Figure 2a and b] after the final release. TTE , as a part of a routine protocol. The device had moved from its previous position [Figure 1c] with a residual shunt seen superior and anterior to the device. This was confirmed on fluoroscopy [Figure 2c]. Although the device was not free floating, a 5F bioptome (Cook Medical Inc., Bloomington, IN) introduced from the right jugular vein was used to stabilize the device [Figure 2d]. An Amplatz goose neck snare (eV3 Endovascular Inc., Plymouth, MN) with a 15 mm diameter was introduced from the right femoral vein via the 10F sheath through a 0.038" tracker catheter, provided with the snare itself, and the device was held by its screw located on the right atrial disk [Figure 2d]. With a pull of gradually increasing intensity on the snare, accompanied by a gentle tension on the bioptome holding the LA disk, it was possible to slenderize the right atrial disk and retrieve it in the long sheath [Figure 2e]. At this juncture, the bioptome was opened and the left atrial disk was released [Figure 2f]. The entire device was subsequently pulled into the sheath [Figure 2g].