Author + information
- Received October 5, 2017
- Revision received October 31, 2017
- Accepted November 7, 2017
- Published online April 2, 2018.
- aMedical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- bGerman Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- cDepartment of Internal Medicine/Cardiology, Heart Center Leipzig–University Hospital, Leipzig, Germany
- ↵∗Address for correspondence:
Dr. Mohammed Saad, Medical Clinic II, University Heart Center Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
An 80-year-old male patient with permanent atrial fibrillation, CHA2DS2VASc score of 6, and HAS-BLED score of 5 was referred for implantation of a left atrial appendage occlusion device (LAAO) because of gastrointestinal bleeding under oral anticoagulation. After implantation of a 28-mm AMPLATZER-Amulet LAAO (St. Jude Medical, Minneapolis, Minnesota), criteria for proper implantation and stability were fulfilled, and the device was released from the delivery system (Figure 1A).
After detachment, the device was dislodged and migrated to the left ventricle (LV) (Figure 1B). The device was freely mobile at the apex and was not caught in the chordae tendineae. To retrieve it, a 24-F steerable MitraClip guide sheath (Abbott Vascular, Santa Clara, California) was introduced into the left atrium after transseptal puncture while a pigtail catheter was introduced retrogradely through the aortic valve to limit the mobility of the LAAO in the LV. To avoid damaging the mitral apparatus while pulling the device back, we did a high transseptal puncture to prevent leaflet damage through forward movement of the guide; while the guide was positioned in a central coaxial plane to the mitral ring to avoid damaging the chordae tendineae with the device. An endoscopy rat tooth grasping forceps (Olympus America, Center Valley, Pennsylvania) (Figures 1C and 1D) was introduced through the MitraClip steerable sheath and was used to grasp and retrieve the LAAO into the sheath, and then the whole system was withdrawn outside the patient (Figures 1E and 1F). Embolization of LAA closure devices is a known complication that occurs in <4% of patients early after implantation (1). In most cases of device embolization into the LV, surgical retrieval is necessary, thereby increasing procedure-related morbidity (2). Transseptal retrieval using a MitraClip steerable sheath and an endoscopy rat tooth grasping forceps can ensure a safe percutaneous retrieval in such cases.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 5, 2017.
- Revision received October 31, 2017.
- Accepted November 7, 2017.
- 2018 American College of Cardiology Foundation