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Xiang K, Ai Q, He L, Fan C. Case report: Amplatzer septal occluder device migration into the descending thoracic aortic isthmus: percutaneous retrieval and redeployment. Front Cardiovasc Med 2023; 10:1269032. [PMID: 37900566 PMCID: PMC10611486 DOI: 10.3389/fcvm.2023.1269032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 10/31/2023] Open
Abstract
Percutaneous closure has emerged as the standard treatment for secundum-type atrial septal defects (ASDs). However, there is a rare but serious complication of occluder device migration and embolization to the heart chambers or distal vasculature during or shortly after implantation. Although this occurrence is extremely rare, it can have disastrous consequences. Fortunately, advancements in equipment and technology have facilitated the transition from surgical procedures to percutaneous techniques for removing embolized occluder devices. In this report, we present a case in which an Amplatzer septal occluder (ASO) device embolized to the descending thoracic aortic isthmus two days after implantation. The device was successfully retrieved using a percutaneous technique, and another ASO device was subsequently redeployed to the ASD. Regrettably, the patient experienced an intraoperative cardiac arrest. Despite prompt rescue efforts and recovery of vital signs, the patient still suffered postoperative sequelae. The main reason for occluder device migration in this case may have been the undersizing of the ASO device due to the operator's lack of caution.
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Affiliation(s)
- Kun Xiang
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Qi Ai
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Lin He
- Department of Cardiology, Shaoyang Central Hospital, Shaoyang, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, China
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2
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Vishwanath V, Akseer S, Frankfurter C, Reza S, Farrell A, Horlick E, Abrahamyan L. Comparative effectiveness of devices for transcatheter closure of atrial septal defects: Systematic review and network meta-analysis. Arch Cardiovasc Dis 2022; 115:664-674. [PMID: 36336619 DOI: 10.1016/j.acvd.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022]
Abstract
Atrial septal defect is a common congenital heart disease, producing a left-to-right shunt in the atrial septum; the current preferred treatment is transcatheter device closure. The aim is to conduct a systematic review to synthesize information on the comparative effectiveness and safety of atrial septal defect closure devices. The methods used: a comprehensive search of Ovid MEDLINE®, Embase, and Cochrane Central databases was conducted. Studies comparing procedural and follow-up outcomes of atrial septal defect devices were included. Network meta-analyses were conducted to generate direct and indirect evidence for comparative effectiveness and safety outcomes between devices. The results are as follows: Twelve studies met our inclusion criteria and were compared in network meta-analyses. The meta-analyses evaluated contemporary devices: the AMPLATZER Septal Occluder; the GORE CARDIOFORM Septal Occluder; the Figulla Flexible II Occluder; the CeraFlex Septal Occluder; and the HELEX Septal Occluder. These studies represented 3998 patients. The primary safety and efficacy outcomes were device embolization and follow-up residual shunt, respectively. Secondary clinical outcomes included procedural success and major and minor complications. No differences were found between devices in terms of device embolization and secondary clinical outcomes. Follow-up residual shunt was higher with the HELEX Septal Occluder compared with the AMPLATZER Septal Occluder (odds ratio 2.92, 95% confidence interval 1.12-7.61). To conclude: although most outcomes were similar between devices, evidence was largely based on observational low-quality studies. There were inconsistencies in outcome reporting and definitions; this merits future studies, with head-to-head device comparisons and standardization of outcomes.
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Affiliation(s)
- Varnita Vishwanath
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Selai Akseer
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Claudia Frankfurter
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Seleman Reza
- Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada
| | - Ashley Farrell
- Library & Information Services, University Health Network, Toronto ON M5G 2C4, Canada
| | - Eric Horlick
- Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre (PMCC), University Health Network, ON M5G 2N2 Toronto, Canada
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network, 10th Floor Eaton North, Room 237, 200, Elizabeth Street, ON M5G 2C4 Toronto, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto ON M5T 3M6, Canada.
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3
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Basantwani S, Sultania N, Jambotkar T. A prospective study of various anesthetic techniques in patients with acyanotic congenital heart diseases undergoing device closure. Ann Card Anaesth 2022; 25:441-446. [DOI: 10.4103/aca.aca_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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4
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Singh D, Singh P, Karna ST. Surgical Retrieval of Embolized Patent Ductus Arteriosus Occluder Device in an Adult after 12 Years of Initial Deployment: A Case Report with Perioperative Considerations and Decision-Making in Resource-Limited Settings. Anesth Essays Res 2020; 14:173-176. [PMID: 32843814 PMCID: PMC7428098 DOI: 10.4103/aer.aer_38_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022] Open
Abstract
Transcatheter closure of patent ductus arteriosus (PDA) is a well-established technique worldwide, with minimal incidence of associated major and minor complications. Surgical closure of PDA is equally effective with negligible mortality risk. We describe a case of an adult with unexpected diagnosis of PDA occluder device embolization in main pulmonary artery, presenting after 12 years of initial device deployment during childhood. Due to persistent duct flow, patient developed severe pulmonary hypertension and congestive heart failure. In this report, we are focusing on perioperative management of surgical retrieval of the embolized device along with the need of intermediate and sometimes long term follow up of patients planned for percutaneous closure, in order to avoid procedure-related complications and associated morbidity and mortality risk. At the same time, the socio-economic aspects of the patient should also be considered in decision-making in terms of choice of transcatheter versus surgical closure of the shunt.
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Affiliation(s)
- Dheer Singh
- Department of Anaesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | - Pooja Singh
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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5
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Prabhu S, Maiya S, Shetty R, Murthy K, Ramachandra P, Tiwari R. Hybrid approach for aortic embolization of Amplatzer duct occluder. Ann Pediatr Cardiol 2020; 13:227-229. [PMID: 32863658 PMCID: PMC7437625 DOI: 10.4103/apc.apc_13_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 03/17/2020] [Indexed: 11/25/2022] Open
Abstract
Embolization of the patent ductus arteriosus (PDA) device is a known adverse event of percutaneous PDA closure, which can lead to complications. Embolization can occur into the pulmonary artery or into the aorta. Device embolization can be moderate adverse event (when retrieved percutaneously) or major adverse event (when retrieved surgically). We are describing a hybrid approach for aortic embolization of PDA device when the percutaneous retrieval fails, where device retrieval and PDA ligation can be done through thoracotomy incision, thus decreasing the complications.
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Affiliation(s)
- Sudesh Prabhu
- Department of Paediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Shreesha Maiya
- Department of Paediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Riyan Shetty
- Paediatric Critical Care Unit, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Keshava Murthy
- Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Prakash Ramachandra
- Department of Paediatric Cardiology, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
| | - Rishi Tiwari
- Department of Paediatric Cardiac Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
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6
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Martínez-Comendador J, Martín E, Gualis J, Castaño M. Surgical management of embolized Amplatzer septal occluder into the left ventricle tangled with the mitral valve. J Card Surg 2020; 35:1687-1689. [PMID: 32400072 DOI: 10.1111/jocs.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Device embolization is a rare major complication of atrial septal defect percutaneous closures which requires surgical management if noninvasive retrieval fails. We report a symptomatic delayed embolization of an Amplatzer septal occluder device into the left ventricle outflow tract tangled with the mitral valve, complicated with ventricular arrhythmias and cardiac tamponade during percutaneous retrieval attempt. Emergent surgical treatment was performed, requiring a combined approach through the right atrium and the aorta for surgical removal.
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Affiliation(s)
| | - Elio Martín
- Department of Cardiac Surgery, Leon University Hospital, Leon, Spain
| | - Javier Gualis
- Department of Cardiac Surgery, Leon University Hospital, Leon, Spain
| | - Mario Castaño
- Department of Cardiac Surgery, Leon University Hospital, Leon, Spain
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Menaissy Y, Alkady H, El-Saiedi S. Rescue Cardiac Surgeries After Pediatric Catheter-Based Interventions: A Ten-Year Retrospective Study. World J Pediatr Congenit Heart Surg 2019; 10:539-542. [PMID: 31496402 DOI: 10.1177/2150135119852318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. METHODS Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. RESULTS There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during balloon valvuloplasty. Median age was 4 years (range, 2 months to 12 years). All rescue surgeries were done via median sternotomy. The mean time interval between the decision to remove the device surgically and the actual surgical procedure was 75 ± 14 minutes. There were no reported cases of postoperative complications or mortality among the patients who underwent surgery. CONCLUSION Our single-center experience confirms that early rescue cardiac surgery to correct adverse events after pediatric transcatheter interventions is safe and effective. Surgical strategies should be tailored according to the situation in each case.
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Affiliation(s)
| | - Hesham Alkady
- Pediatric Cardiac Surgery, Cairo University, Cairo, Egypt
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8
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Manolis AS. Percutaneous retrieval of a dislodged Amplatzer septal occluder device from the pulmonary artery with sole use of a snare and device lassoing. Hellenic J Cardiol 2018; 59:57-59. [DOI: 10.1016/j.hjc.2017.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/25/2022] Open
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9
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Yates MT, Anderson DR. Safe Surgical Retrieval of Embolized Atrial Septal Defect Closure Device. Ann Thorac Surg 2017; 103:e213-e214. [PMID: 28109396 DOI: 10.1016/j.athoracsur.2016.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/06/2016] [Indexed: 11/30/2022]
Abstract
Surgical retrieval of atrial septal closure device is associated with significant morbidity. We present a technique for safer removal of such devices from the heart.
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Affiliation(s)
- Martin T Yates
- Department of Cardiac Surgery, Guys and St. Thomas' Hospital, London, United Kingdom
| | - David R Anderson
- Department of Cardiac Surgery, Guys and St. Thomas' Hospital, London, United Kingdom.
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Varrica A, Lo Rito M, Generali T, Satriano A, D'Oria V, Conforti E, Pluchinotta F, Chessa M, Butera G, Frigiola A, Carminati M, Giamberti A. Surgical rescue after transcatheter interventional procedures in congenital heart disease patients: an existing problem. EUROINTERVENTION 2017; 12:1724-1729. [PMID: 27773863 DOI: 10.4244/eij-d-16-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Nowadays, transcatheter approaches are the treatment of choice for several congenital heart defects. However, adverse events may occur during interventional procedures. Even if the complication rate has been reduced remarkably because of learning curve and technological improvements, catastrophic events are still possible. The aim of this study was to review cardiac catheter complications that required surgical treatment during or after a percutaneous procedure. METHODS AND RESULTS We evaluated retrospectively a thirteen-year experience at our centre. We examined all transcatheter procedures involving device release or implantation needing surgical rescue. We performed 3,205 interventional catheterisation procedures with device release or implantation: ASD device closure (n=2,205), PDA device occlusion (n=355), VSD device closure (n=218), aortic coarctation or recoarctation stenting (n=199), pulmonary artery stenting (n=154) and pulmonary valve implantation (n=74). Complications that required surgical treatment occurred in 1.2% of cases. Early surgery was performed in 22 cases, while in 18 patients a surgical treatment related to late complications was performed in a mean follow-up of 17 months. There were no deaths in either group. CONCLUSIONS A spectrum of CHD can be treated today by transcatheter interventional procedures with good results and a low, but not negligible, risk of complications that require a surgical operation. The risk of developing late complications makes a long-term follow-up mandatory in such patients.
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Affiliation(s)
- Alessandro Varrica
- Department of Pediatric Cardiac Surgery, IRCCS San Donato Milanese Hospital, San Donato Milanese, Italy
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11
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Vaidhya N, Mishra A, Siddiqui S, Joshi H, Patel H. Surgical Removal of Embolized Ventricular Septal Occluder Device. World J Pediatr Congenit Heart Surg 2016; 8:537-539. [PMID: 27198525 DOI: 10.1177/2150135116648306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ventricular septal defect (VSD) with valvar pulmonary stenosis (PS) is a combination of cardiac defects for which treatment by means of percutaneous catheter-directed intervention is sometimes considered. Septal occluder device embolization is a rare but potentially dreadful complication. Adequate precautions are of great importance, as operator-related and anatomical factors can contribute to the risk of device embolization. In this report, we present a case of a five-year-old patient with a perimembranous VSD and valvar PS with infundibular muscle hypertrophy. The PS was treated with balloon pulmonary valvotomy, and the VSD was closed with a catheter-directed duct occluder device. Soon after deployment, the device embolized to the aortic arch, possibly as a result of the single disc device being "milked" out of VSD by dynamic contractions of hypertrophied muscle in the right ventricular outflow tract. The embolized device was successfully retrieved and removed using cardiopulmonary bypass and a period of circulatory arrest.
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Affiliation(s)
- Nikunj Vaidhya
- 1 Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Amit Mishra
- 2 Department of Pediatric Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Sumbul Siddiqui
- 1 Department of Cardiovascular and Thoracic Surgery, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Harshil Joshi
- 3 Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India
| | - Hardik Patel
- 3 Department of Cardiac Anesthesia, U.N. Mehta Institute of Cardiology and Research Center (affiliated to B.J. Medical College, Ahmedabad), Civil Hospital Campus, Asarwa, Ahmedabad, India
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12
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Khan MA, Almashham YH, Almoukirish ARS, Momenah TS. Embolized amplatzer duct occluder to aorta: Retrieval technique. J Saudi Heart Assoc 2016; 28:116-8. [PMID: 27053902 PMCID: PMC4803766 DOI: 10.1016/j.jsha.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/13/2015] [Accepted: 11/09/2015] [Indexed: 12/05/2022] Open
Abstract
A 4-year-old girl had an Amplatzer duct occluder embolized to the descending aorta immediately after closure of patent ductus arteriosus: a novel technique of retrieval.
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Affiliation(s)
- Muhammad A. Khan
- Department of Pediatric Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yahya H. Almashham
- Department of Pediatric Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Tarek S. Momenah
- Department of Pediatric Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, Saudi Arabia
- Corresponding author at: King Fahad Medical City, King Salman Heart Center, P.O. Box 59046, Riyadh 11525, Saudi Arabia.King Fahad Medical CityKing Salman Heart CenterP.O. Box 59046Riyadh11525Saudi Arabia
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Mantilla JM, Olaya JL, Enriquez MF, Vanegas E, Cely-Andrade JL. Tratamiento quirúrgico en un caso de migración de Amplatzer® en un menor con persistencia del conducto arterioso. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Retrieval of malpositioned Atrial Septal Occluder (ASO) devices: call for guidelines. Pediatr Cardiol 2015; 36:884-5. [PMID: 25645098 DOI: 10.1007/s00246-015-1124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
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15
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Tai S, Tang L, Zhu ZW, Fang ZF, Hu XQ, Tang JJ, Zhou SH. Embolisation of perimembranous ventricular septal defect occluder and transcatheter retrieval. Heart Lung Circ 2014; 23:951-6. [PMID: 24816142 DOI: 10.1016/j.hlc.2014.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 11/30/2022]
Abstract
AIMS In this study, we aim to summarise our experience with techniques used for the transcatheter retrieval of embolised devices. METHODS We retrospectively reviewed the transcatheter retrieval of embolised devices in seven patients who underwent an attempted transcatheter closure of perimembranous ventricular septal defects (PMVSDs) between October 2002 and October 2013. The incidence, the main causes for the device's embolisation, and the techniques for transcatheter retrieval of the embolised device are discussed. RESULTS The incidence of device embolisation in our centre was 0.82% (seven embolisations in 852 device placements). The main causes for device embolisation included undersized devices and inadequate subaortic rims. Among the seven embolisations, six of the devices were retrieved percutaneously without mortality, while one was retrieved during surgery. Of these patients, five had a HeartR(TM) Membranous VSD occluder of their PMVSDs, and the remaining two had surgical PMVSD closures. CONCLUSIONS Our approach to the transcatheter retrieval of the embolised devices is associated with good results.
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Affiliation(s)
- Shi Tai
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Liang Tang
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhao-wei Zhu
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Zhen-fei Fang
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Xin-qun Hu
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China.
| | - Jian-jun Tang
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Sheng-hua Zhou
- Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, China
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