Author + information
- Received September 23, 2016
- Accepted October 6, 2016
- Published online January 2, 2017.
- Oh-Hyun Lee, MD,
- Hancheol Lee, MD and
- Jung-Sun Kim, MD, PhD∗ ()
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- ↵∗Reprint requests and correspondence:
Dr. Jung-Sun Kim, Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 03722 Yonsei-ro 50-1, Seodaemun-gu, Seoul, Korea.
A 70-year-old man with persistent atrial fibrillation was referred for percutaneous left atrial appendage occlusion. Because of a high cardioembolic stroke risk (with a CHA2DS2-VASc score of 3 points) and given his previous history of gastric bleeding during anticoagulation treatment, we decided to perform left atrial appendage closure. We successfully deployed a 28-mm AMPLATZER Cardiac Plug (ACP) (St. Jude Medical, Minneapolis, Minnesota) device (Figures 1A and 1B).
However, frequent premature ventricular complexes were observed after procedure. The patient remained asymptomatic, but a displaced ACP device was observed at bedside transthoracic echocardiography. Concerning device embolization and dynamic obstruction, we decided to retrieve the device immediately.
Fluoroscopic images showed a displaced and floating device in left atrium (Figure 1C, Online Video 1). When the device was entrapped in mitral valve (Figures 2B and 2C), we found the suddenly dropped the blood pressure and premature ventricular complexes (Figure 2A). A 30-mm multisnare was introduced to capture the disc for support and then a 5-mm snare was used to grab the distal screw tip (Figure 1D, Online Videos 2 and 3). After that, the device was retracted cautiously (Figure 1D, Online Video 4). There was no acute complication during retrieval and a possible mechanism for migration of the device might be device oversizing. A 26-mm ACP device was successfully deployed (Figures 1E and 1F). Post-procedural transesophageal echocardiography and computed tomography scans obtained 2 days after procedure demonstrated no device embolization or acute complications. The patient was discharged 7 days after the procedure and has been uneventful thereafter for 6 months.
Device embolization is rare but a serious complication with possible disastrous consequences. When the device is entrapped in the mitral valve apparatus or has migrated into the left ventricle, percutaneous retrieval using multiple snare loops could be considered.
For supplemental videos and their legends, please see the online version of this article.
Dr. Kim has served as a consultant for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 23, 2016.
- Accepted October 6, 2016.
- American College of Cardiology Foundation