Author + information
- Received November 8, 2017
- Accepted November 28, 2017
- Published online April 16, 2018.
- Hai-Ying Li, MD,
- Xin-Lei Wu, MD,
- Fang-Yi Xiao, MD,
- Xiao-Dong Zhou, MD,
- Ye Chen, MD and
- Wei-Jian Huang, MD∗ ()
- Department of Cardiovascular Medicine, the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- ↵∗Address for correspondence:
Dr. Wei-Jian Huang, Department of Cardiovascular Medicine, The Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
An 84-year-old man with permanent atrial fibrillation was referred for left atrial appendage (LAA) occlusion with a CHA2DS2-VASc score of 3 and a HAS-BLED score of 4. Pre-operative transesophageal echocardiography identified a LAA ostial diameter of 30 mm. A 33-mm Watchman device (Boston Scientific, Marlborough, Massachusetts) was chosen to be implanted into the LAA. During the procedure, the device was detached from the transport sheathing (Figure 1). To recapture the dislocated device, we decided that grasping forceps (Olympus, Solna, Sweden) should be used to grasp the detached device via femoral access. After numerous external attempts, we found that only by clipping the device’s hub (and not the basilar part or body) the device be pulled into a 12-F sheath (FlexCath Advance 4FC12, Medtronic CryoCath LP, both Medtronic, Minneapolis, Minnesota) (Figure 2). However, this attempt failed. We then found that the ideal position should be coaxial, with the grasping forceps and device hub in the same direction. Two alligator cups biopsy forceps (Zhuji Pengtian Medical Instrument Co., Ltd, Zhuji, China) were used. One was used to grasp the device body and prevent device motion; the other was positioned coaxially to grasp the device hub. The coaxial alignment was confirmed by multidirectional projections under fluoroscopy. Finally, the device was retrieved (Figure 3).
To our knowledge, a case of large-diameter (33 mm) Watchman device detachment in the left atrium during the procedure has not yet been described. Furthermore, the detached Watchman device was retrieved though a double sheath and biopsy forceps technique. Perrotta et al. (1) also reported a case of percutaneous retrieval of a dislodged LAA occlusion device (Amplatzer Cardiac Plug, St. Jude Medical, St. Paul, Minnesota) with a diameter of 30 mm using a 24-F steerable sheath with a double-snare technique. If the detached device is trapped in the mitral valve apparatus or embolized to the left ventricular outflow tract, surgical retrieval should be performed as soon as possible. While the detached device is trapped in the left atrium, percutaneous retrieval should be attempted.
The authors thank Cody R. Hou and Nicole Gordon for their assistance in manuscript preparation.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 8, 2017.
- Accepted November 28, 2017.
- 2018 American College of Cardiology Foundation