An extremely rare but considerably important device-related complication of percutaneous atrial septal defect closure

RevPortCardiol.2018;37(2):209---210

www.revportcardiol.org

Revista

Portuguesa

de

Cardiologia

Portuguese

Journal

of

Cardiology

IMAGE

IN

CARDIOLOGY

An

extremely

rare

but

considerably

important

device-related

complication

of

percutaneous

atrial

septal

defect

closure

Uma

complicac

¸ão

extremamente

rara

mas

consideravelmente

importante

relacionada

com

dispositivo

de

encerramento

percutâneo

da

comunicac

¸ão

interauricular

Yusuf

I.

Alihanoglu

_,

_Dogu

_I.

_Kilic

_,

_Bekir

_S.

_Yildiz

_,

_Bilgin

_Emrecan

_,

_Harun

_Evrengul

b_{PamukkaleUniversitySchoolofMedicine,DepartmentofCardiovascularSurgery,Denizli,Turkey}

Received19November2016;accepted22December2016 Availableonline31December2017

A21-year-oldmalewitha27-mmatrialseptaldefect(ASD) underwentanuneventfulpercutaneousdeviceclosureusing a 28-mm Ultrasept ASD Occluder with super-low profile (Cardia,Inc.,USA)undertransoesophageal echocardiogra-phy (TEE) guidance.We particularly favoured thiskind of occluderdeviceduetothepossiblefutureneedforcatheter atrial septostomyin suchayoungpatient.The useofTEE

Figure1 TEEimagesdemonstratethattheoccluderdevicewasproperlydeployedinthemiddlepartoftheinteratrialseptum (A)andtherewasnoresidualshuntthroughit(B).

∗_{Correspondingauthor.}

E-mailaddress:aliizyu@mynet.com(Y.I.Alihanoglu).

duringtheprocedureensuredthattheoccluderdevicewas properlydeployedinthemiddlepartoftheinteratrial sep-tumandtherewasnoresidualshuntthroughit(Figure1). Therewere alsonoproblems withthe occluderdevice at 1-monthfollow-up.However,fourmonthsafterthe proce-dure, thepatient presented again withvague chest pain, palpitations andshortness of breath. The physical

exami-https://doi.org/10.1016/j.repc.2016.12.019

210 Y.I.Alihanogluetal.

Figure2 Intraoperativeimagingshowingthatallmarginsoftheoccluderdevicewereproperlyattachedtotheinteratrialseptum andtherewasnodisplacement.

Figure3 Imagingoftheoccluderdeviceaftersurgicalextractionfromthefront(A)andtheback(B)sites.

nationwasunremarkable. Transthoracic echocardiography (TTE),followedbyTEE,revealed asignificant left-to-right shunt, although the device was clearly seen in the mid-dlepart of theinteratrial septum.The initial differential diagnosis included partialdisplacement of the deviceand therefore,thepatientwasreferredtosurgery,allmargins oftheoccluderdevicewerefoundtobeproperlyattached to the interatrial septum during the surgery (Figure 2). Interestingly, the central patch of the device had almost completely disappeared (Figure 3). Surgical repair of the atrialseptumwasperformedsuccessfullyafterremovingthe metallicpartofthedevice.Therewerenosignsofemboliin thebrainorpulmonaryvasculatureonthecomputed tomo-graphyscan,whichwasperformedfollowingthesurgeryfor anypossibleembolisationofthepatchmaterial.Thepatient wasdischargedfromthehospitalwithoutanycomplications andingoodhealth.

Inconclusion,althoughdeviceclosureofASDscansafely be performed percutaneously, recanalisation may occur on rare occasions, probably due to device characteris-tics of the Ultrasept ASD Occluder. While ASD occluder devicesfromthisbrandareusuallypreferredduetotheir super-low profile, this feature of the devices may not provide necessary support and resistance in the intera-trial septum. As a matter of fact, the last generation of Ultrasept ASD Occluder devices have an extra layer between the two other layers, indicating this kind of necessity.

Conflicts

of

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