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Aylin Yıldırır Birgül Varan

#

İlkay Erdoğan

#

Fatih Boyvat

Departments of Cardiology,

#

Pediatric Cardiology,

Radiology, Baskent University Faculty of Medicine,

Ankara, Turkey

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A 45-year-old female patient was referred to our Cardiology Out- patient Clinic after an embolic cerebrovascu- lar event. Echocardio- graphic examination revealed a tunnel type patent foramen ovale (PFO), and trans- esophageal echocar- diography (TEE) con-

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shunt (Fig. A, Movie 1). Her other echocardiographic

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aortic and tricuspid regurgitation. Complete neuro- logical and laboratory investigations were performed including immunologic, rheumatologic, and genetic studies, which did not show any underlying pathology for cryptogenic stroke other than the PFO. Therefore, percutaneous closure of the PFO was planned with an Amplatzer PFO occluder (AGA Medical Corporation, Golden Valley, MN) device. After a diagnostic left and right heart catheterization, the procedure to close the PFO was planned under general anesthesia with WKHJXLGDQFHRI7((DQGÀXRURVFRS\$PP3)2

closure device was selected. It took three attempts to position the device and three retrievals into the intro- ducer sheath, but at each attempt the device could not be placed in an appropriate position. Therefore, a 15 mm ASD occluder device (AGA Medical Corpora- tion, Golden Valley, MN) was selected, and after con-

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the device was released. In a few seconds after re- lease, the device was embolized to the left atrium, the left ventricle, then to the aorta, where it was stabilized in the descending aorta in a vertical position (Fig. B).

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location and position of the embolized device in the descending aorta distal to the left subclavian artery 0RYLH  7R UHVFXH WKH GHYLFH D  ) ORQJ LQWUR- ducer sheath was placed into the contralateral femo- ral artery and a 6 F guiding catheter was advanced.

With a goose-neck snare (Amplatz GooseNeck Snare NLWHY01 WKHHPEROL]HGGHYLFHZDV¿UVWFDSWXUHG

from its discs and pulled until it reached the abdomi- nal aorta. However, to get the device safely into the introducer sheath the snare should capture the device from the screw site. After several attempts, the de- vice was captured from the screw site and completely taken into the introducer sheath (Fig. C, Movie 3).

The system was removed from the femoral artery and the bleeding could be controlled with manual com- pression.



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