PMC5223011_01
(a) Sizing balloon showing the diameter of the ASD. (b) Intracardiac echocardiogram showing the diameter of the ASD.
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fig1
ASD closure was performed using a 16 mm Amplatzer Septal Occluder (ASO) device after measuring the diameter of the defect at 15.4 +- 1.0 mm (Figure 1(a)) with sizing balloon and 15 mm (Figure 1(b)) with intracardiac echocardiogram (ICE). After the deployment of the device, ICE showed minimal residual shunt flow confirming correct position.
(a) Chest radiograph, lateral view showing the embolized ASO. (b) Aortic arch angiography using angled pigtail catheter. (c) Using En-Snare, capturing of the metallic tip of the right atrial disc of the ASO. (d) Retraction of the entire ASO into the long cook sheath.
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fig2
ASD, without visualization of the ASO device. A chest radiograph (Figure 2(a)) showed the embolized ASO device in the aortic arch. ASO device and placement of a newer device. 6 F x 11 cm sheath was placed in right femoral artery. Aortic arch angiography was performed with a 5 F x 110 cm pigtail catheter (Figure 2(b)). 6 F sheath was then exchanged with a 10 F x 80 cm long cook sheath (Cook Medical System (Merit Medical Systems, Inc., Utah) through a 6 F Hockey Stick II guiding catheter (Medtronic Inc., Minnesota), we were able to snare the metallic tip on the right atrial disc of ASO device (Figure 2(c)). Subsequently, entire device was collapsed into the long sheath which was safely removed (Figure 2(d)).
(a) Resizing of the ASD using the sizing balloon. (b) Resizing of the ASD using the intracardiac echocardiogram.
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fig3
This time the sizing balloon yielded diameter of 17.41 mm (Figure 3(a)) and ICE of 18 mm (Figure 3(b)).