Author + information
- Received September 23, 2014
- Accepted October 23, 2014
- Published online April 27, 2015.
- Michael Zacharias, DO∗ ( and )
- Ravi Dhingra, MD, MPH
- University of Wisconsin Hospital and Clinics, Advanced Heart Failure and Cardiac Transplant Program, Division of Cardiology, Department of Medicine, University of Wisconsin, Madison, Wisconsin
- ↵∗Reprint requests and correspondence:
Dr. Michael Zacharias, University of Wisconsin Hospital and Clinics, Advanced Heart Failure and Cardiac Transplant, 600 Highland Avenue, MC 5710, Madison, Wisconsin 53792.
A 29-year-old man with congenitally corrected transposition of the great arteries underwent implantation of a HeartMate II left ventricular assist device (LVAD) (Thoratec Corp, Pleasanton, California) as a result of worsening systemic right ventricular failure and New York Heart Association class IV symptoms, as a bridge to transplant. After 6 months, he presented with atrial arrhythmias and abdominal bloating. A repeat transthoracic echocardiogram demonstrated severe continuous aortic insufficiency, which previously had been mild. He was referred to the cardiac catheterization laboratory for a hemodynamic assessment and possible use of an Amplatzer Septal Occluder (AGA Medical, Plymouth, Minnesota) for closure of his aortic valve. Right heart catheterization hemodynamics showed a right atrial pressure of 16 mm Hg, pulmonary artery pressure of 49/22 mm Hg, and pulmonary wedge pressure of 18 mm Hg. Via the right femoral artery, a 30-mm Amplatzer atrial septal cribriform device was advanced across the aortic valve and positioned under transesophageal echocardiogram guidance. To and fro motion was performed to test stability, and the device appeared secure with minimal residual aortic insufficiency. The device was released and stayed in a stable position, which was also confirmed by chest x-ray (Figure 1A). This technique has been previously described with success through a femoral (1) and subclavian (2) approach. The following day, a chest x-ray demonstrated that the device had migrated into the left ventricle (Figure 1B). An emergent computed tomography scan of the chest was performed that showed that the Occluder device had migrated to the orifice of LVAD inflow cannula (Figure 2). The LVAD speed was reduced to prevent the device from completely obstructing the LVAD inflow cannula. Luckily, a donor heart became available on the same night, and the patient was successfully transplanted without any complications. Although a Septal Occluder device has previously been described to improve aortic insufficiency; it does so with potential risk.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 23, 2014.
- Accepted October 23, 2014.
- American College of Cardiology Foundation
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