Author + information
- Received November 4, 2016
- Accepted November 17, 2016
- Published online February 6, 2017.
- Santosh K. Padala, MDa,
- Aditya Saini, MDa,
- Zachary M. Gertz, MDa,
- Gordon S. Morano, MDb,
- Kenneth A. Ellenbogen, MDa and
- Jayanthi N. Koneru, MBBSa,∗ ()
- aDivision of Cardiology, Virginia Commonwealth University, Richmond, Virginia
- bDivision of Radiology, Virginia Commonwealth University, Richmond, Virginia
- ↵∗Address for correspondence:
Dr. Jayanthi N. Koneru, Division of Cardiology, Virginia Commonwealth University, Gateway Building, 3rd Floor, 3-216, 1200 East Marshall Street, Richmond, Virginia 23219.
A 56-year-old woman with large ostium secundum atrial septal defect (ASD) and severe right ventricular dysfunction was referred for percutaneous ASD closure.
The ASD measured 25 mm on fluoroscopy (Figure 1A). A 26-mm Amplatzer septal occluder (AGA Medical, Golden Valley, Minnesota) was delivered using a “push–pull” technique; however, the device embolized into the left atrium (Figures 1B and 1C). The device was retrieved into the right atrium (RA) (Online Video 1). While attempting to retract it from the RA, it embolized to the right ventricle (RV) and could not be snared despite multiple attempts.
Two steerable 8.5-F Agilis sheaths (St. Jude Medical, Inc., St. Paul, Minnesota) were advanced into RA. A 20-pole adjustable circular Lasso catheter (Biosense Webster, Diamond Bar, California) and bioptome forceps were advanced through these sheaths. The ASD device was snared with the Lasso catheter and retrieved back into RA (Figures 1D and 1E). However, it repetitively embolized to the RV. A second Lasso catheter was then advanced into the RA. Immediately after retrieval of the device with the first Lasso catheter into the RA, the circular catheter was positioned at the tricuspid valve to prevent device re-embolization into the RV. The second Lasso catheter was used to jail the device against posterior RA wall (Online Video 2). The device was then retracted down into the inferior vena cava and snared with a gooseneck snare and successfully retrieved back into the sheath (Online Video 3). A month later, the ASD was successfully closed percutaneously with a 30 mm Amplatzer occluder device (AGA Medical).
Embolization of an ASD occluder device is a rare complication with reported incidence of 0.6% to 1.1% (1,2), with about two-thirds of cases requiring surgical retrieval (2). Successful transcatheter retrieval has been reported using tools such as a pigtail catheter, snare, or bioptome forceps (3,4). This is the first reported case that used 2 Lasso catheters and steerable sheaths (used primarily for pulmonary vein ablation procedures) for the retrieval of an embolized ASD occluder device from RV, thus avoiding a major open heart surgical approach. Extreme caution is advised against using this approach on the left side due to risk of Lasso catheter entrapment in the mitral valve apparatus.
For supplemental videos and their legends, please see the online version of this article.
Dr. Ellenbogen has received honoraria from Atricure, Biosense Webster, Medtronic, Boston Scientific, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 4, 2016.
- Accepted November 17, 2016.
- American College of Cardiology Foundation
- DiBardino D.J.,
- McElhinney D.B.,
- Kaza A.K.,
- Mayer J.E.
- Vasquez A.F.,
- Lasala J.M.