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Kim S, Min S. Surgical Removal of Migrated Atrial Septal Defect Closure Device: A Case Report. Vasc Specialist Int 2022; 38:24. [PMID: 36172798 PMCID: PMC9520317 DOI: 10.5758/vsi.220033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/20/2022] Open
Abstract
Percutaneous closure of atrial septal defects (ASDs) has emerged as an alternative to surgical treatment; however, several early and late complications have been reported. In this report, we present the case of a patient who underwent surgical removal of a migrated ‘Figulla Flex II’ ASD occlusion device at the aortic bifurcation 2 months after ASD occlusion.
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Affiliation(s)
- Sunjoo Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sangil Min
- Division of Transplantation and Vascular Surgery, Department of Surgery, Seoul National University Hospital, Seoul, Korea
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2
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Singh M, Varela CE, Whyte W, Horvath MA, Tan NCS, Ong CB, Liang P, Schermerhorn ML, Roche ET, Steele TWJ. Minimally invasive electroceutical catheter for endoluminal defect sealing. SCIENCE ADVANCES 2021; 7:eabf6855. [PMID: 33811080 PMCID: PMC11057783 DOI: 10.1126/sciadv.abf6855] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Surgical repair of lumen defects is associated with periprocedural morbidity and mortality. Endovascular repair with tissue adhesives may reduce host tissue damage, but current bioadhesive designs do not support minimally invasive deployment. Voltage-activated tissue adhesives offer a new strategy for endoluminal repair. To facilitate the clinical translation of voltage-activated adhesives, an electroceutical patch (ePATCH) paired with a minimally invasive catheter with retractable electrodes (CATRE) is challenged against the repair of in vivo and ex vivo lumen defects. The ePATCH/CATRE platform demonstrates the sealing of lumen defects up to 2 millimeters in diameter on wet tissue substrates. Water-tight seals are flexible and resilient, withstanding over 20,000 physiological relevant stress/strain cycles. No disruption to electrical signals was observed when the ePATCH was electrically activated on the beating heart. The ePATCH/CATRE platform has diverse potential applications ranging from endovascular treatment of pseudo-aneurysms/fistulas to bioelectrodes toward electrophysiological mapping.
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Affiliation(s)
- Manisha Singh
- NTU-Northwestern Institute for Nanomedicine (NNIN), Interdisciplinary Graduate School (IGS), Nanyang Technological University (NTU), 50 Nanyang Drive, Singapore 637553, Singapore
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Claudia E Varela
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - William Whyte
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Markus A Horvath
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA 02139, USA
| | - Nigel C S Tan
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
| | - Chee Bing Ong
- Histopathology/Advanced Molecular Pathology Lab, Institute of Molecular and Cell Biology (IMCB), Agency for Science, Technology, and Research, 61 Biopolis Drive, Singapore 138673, Singapore
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Terry W J Steele
- NTU-Northwestern Institute for Nanomedicine (NNIN), Interdisciplinary Graduate School (IGS), Nanyang Technological University (NTU), 50 Nanyang Drive, Singapore 637553, Singapore.
- School of Materials Science and Engineering (MSE), Nanyang Technological University (NTU), Singapore 639798, Singapore
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3
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Canovai E, Ceulemans LJ, Gilbo N, Duchateau NM, De Hertogh G, Hiele M, Jochmans I, Vanuytsel T, Maleux G, Verhaegen M, Monbaliu D, Pirenne J. Multivisceral Transplantation for Diffuse Portomesenteric Thrombosis: Lessons Learned for Surgical Optimization. Front Surg 2021; 8:645302. [PMID: 33681286 PMCID: PMC7933591 DOI: 10.3389/fsurg.2021.645302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions. Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed. Results: Five patients underwent MVTx. Median age was 47 years (23–62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0–5)]. Median CIT was 330 min (316–416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3–5.9). Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome.
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Affiliation(s)
- Emilio Canovai
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Chronic Diseases, Metabolism and Ageing, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Nicholas Gilbo
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Nicolas M Duchateau
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Hertogh
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Martin Hiele
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Marleen Verhaegen
- Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, Leuven, Belgium.,Leuven Intestinal Failure and Transplantation Center, University Hospitals Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Leuven, Belgium
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Maldonado Fernández N, López Espada C, Linares Palomino JP, Pérez Vallecillos P, García Róspide V. Migration and Surgical Retrieval of an Amplatzer Septal Occluder into Abdominal Aorta. Ann Vasc Surg 2020; 69:449.e11-449.e16. [PMID: 32502671 DOI: 10.1016/j.avsg.2020.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Structural heart defects, secondary to congenital malformations, have been commonly repaired by open cardiac surgery. Endovascular technology enables these repairs to be performed with fewer complications and better recovery. However, endovascular therapy can be associated with major complications as device dislocation or embolization. We present the case of migration of an Amplatzer occluder device into the abdominal aorta and its surgical retrieval. CLINICAL CASE A 10-year-old child with ostium secundum-type interatrial communication underwent endovascular repair in our center. Cardiologists sorted out the atrial communication by endovascular deployment of an Amplatzer device. The 24-h ultrasound control study showed the loss of the occluder. An angio-CT scan showed the migration of the Amplatzer into the juxtarenal abdominal aorta. Initially, an endovascular rescue was attempted but was not effective. Our vascular team performed a median laparotomy, control of the abdominal aorta proximal to the renal arteries, and control of the renal arteries and the infrarenal aorta. We performed a transverse arteriotomy, and the material was removed. Subsequently, the arteriotomy was closed directly without any patch. Postoperative evolution was uneventful. COMMENTS Most of the migrations and embolizations of the devices to close interatrial communications remain intracardiac. Although embolization of the abdominal aorta is only reported sporadically, it could cause a major vascular complication. Percutaneous retrieval of the device is currently recommended, with conventional surgery being the efficient treatment in case of endovascular failure or severe damage to the aorta.
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Affiliation(s)
- Nicolás Maldonado Fernández
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
| | - Cristina López Espada
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain.
| | | | - Pablo Pérez Vallecillos
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
| | - Vicente García Róspide
- Department of Vascular Surgery, Vascular Surgery Unit, University Hospital Virgen de las Nieves of Granada, Spain
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Filippone G, La Barbera G, Valentino F, Ocello S, Talarico F. Transcatheter retrieval of Amplatzer Septal Occluder device embolized into the abdominal aorta. SAGE Open Med Case Rep 2019; 7:2050313X19842462. [PMID: 31007924 PMCID: PMC6458657 DOI: 10.1177/2050313x19842462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/11/2019] [Indexed: 11/15/2022] Open
Abstract
The use of Amplatzer Septal Occluder device has become an alternative to surgical procedure in selected group of patients affected by atrial septal defect. Percutaneous closure of atrial septal defect has emerged as a low morbidity procedure but, at the same time, showed various complications associated to the device itself. Although embolization to the abdominal aorta is only sporadic reported, it could represent a potential vascular disaster and usually is treated by surgery. Herein, we report on the fourth, in English literature, successfully total transcatheter retrieval of an Amplatzer Septal Occluder device complicated by acute embolization into the abdominal aorta and propose a practical endovascular manoeuvre to address disc removal.
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Affiliation(s)
- Gianfranco Filippone
- Gianfranco Filippone, Unit of Vascular and Endovascular Surgery, Ospedale Civico, Via Giuseppe Giusti, 3, 90144 Palermo, Italy.
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Crawford DA, Naidu SG, Shah AA, Davila VJ, Stone WM. Endovascular Retrieval of an Embolized Atrial Septal Occluder Device From the Abdominal Aorta. Vasc Endovascular Surg 2018; 52:669-673. [DOI: 10.1177/1538574418790393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patent foramen ovale (PFO) is a common heart condition in adults. Closure with a septal occluder device is a safe, well-established treatment option with excellent clinical outcomes. One rare complication of percutaneous PFO closure is embolization of the device to the heart chambers or distal vasculature. Most device migrations are recognized during or shortly after implantation. While many endovascular retrievals of migrated devices are successful, there are still a high percentage of surgical interventions performed. We report a case of a septal occluder device that embolized to the abdominal aorta and was discovered 7 days after implantation. Endovascular techniques with a snare and endobronchial forceps were used to retrieve the device safely.
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Affiliation(s)
| | - Sailen G. Naidu
- Division of Interventional Radiology, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Adil A. Shah
- Howard University Hospital and College of Medicine, Washington, DC, USA
| | - Victor J. Davila
- Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - William M. Stone
- Division of Vascular Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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Ramalingam R, Patil S, Setty N, Kharge J, Puttegowda B, Rachaiah JM, Manjunath CN. Tough, but not impossible - Retrieval of large atrial septal occluder devices embolized to left atrium. Interv Med Appl Sci 2017; 9:42-46. [PMID: 28932495 PMCID: PMC5598121 DOI: 10.1556/1646.9.2017.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Atrial septal defect (ASD) is a congenital heart defect that is being increasingly treated using percutaneous interventions. However, these techniques are not devoid of complications. One such complication is device embolization. Removal of such closure device poses tremendous risk and consequent complications both by percutaneous retrieval and surgical removal. Herein, we present two cases of ASDs that were closed using atrial septal occluder, but the devices were subsequently embolized into left atrium. These devices were then percutaneously retrieved without any further complication or injury.
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Affiliation(s)
- Rangaraj Ramalingam
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
| | - Shivanand Patil
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
| | - Natraj Setty
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
| | - Jayashree Kharge
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
| | - Beeresha Puttegowda
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
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Silvestre JMDS, Silvestre GDS, Sardinha WE, Ramires ED, Morais Filho DD, Schimit GTF, Matsuda HM, Ramos DB. Complicação após tratamento percutâneo de comunicação interatrial: migração de dispositivo Amplatzer® para bifurcação aórtica – relato de caso. J Vasc Bras 2015. [DOI: 10.1590/1677-5449-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ResumoCom o uso crescente do dispositivo Amplatzer® para diversos procedimentos endovasculares, dentre os quais a comunicação interatrial, complicações decorrentes de seu uso vêm sendo descritas. Relatamos um caso em que o dispositivo foi empregado para correção de comunicação interatrial e, seis meses depois, migrou para a bifurcação da aorta abdominal. A retirada do corpo estranho foi realizada por cirurgia convencional, após insucesso de tentativa por via endovascular.
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Martínez-Quintana E, Rodríguez-González F. Risks Factors for Atrial Septal Defect Occlusion Device Migration. Int J Angiol 2014; 25:e63-e65. [PMID: 28031657 DOI: 10.1055/s-0034-1395976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial septal defect (ASD) is one of the most common congenital heart defects requiring procedural intervention. In such cases, transcatheter closure of secundum ASDs has been demonstrated to be safe and effective in both children and adults, with similar success and complication rates to surgery. However, appropriate patient selection and an accurate device selection is mandatory to prevent serious complications such as ventricular arrhythmias, outflow tract obstruction of the left and right ventricle, or ischemic events secondary to the obstruction of blood flow due to device embolization.
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Affiliation(s)
- Efrén Martínez-Quintana
- Cardiology Service, Insular-Materno Infantil University Hospital, Las Palmas, Gran Canaria, Spain
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