Emergency surgical approach to device emboli due to migration of the atrial septal defect occluder |
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Authors: | Ufuk Yetkin Ismail Yurekli Zehra Ilke Akyildiz Orhan Gokalp Omer Tetik Banu Lafci Oktay Ergene Ali Gurbuz |
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Affiliation: | 1.Department of Cardiovascular Surgery, Izmir Ataturk Education and Research Hospital, Izmir, Turkey;2.Department of Cardiology, Izmir Ataturk Education and Research Hospital, Izmir, Turkey;3.Department of Cardiovascular Surgery, Bursa Yuksek Ihtisas Hospital, Bursa, Turkey |
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Abstract: | IntroductionAtrial septal defect (ASD) transcatheter occlusion techniques are now established as the preferred method and have become an alternative to surgery under extracorporeal circulation. In this study, we aimed to present our emergency surgical approach to cases of device embolization due to migration of the atrial septal defect occluder.Material and methodsBetween June 2009 and June 2011, 6 patients underwent emergency operations due to device emboli secondary to migration of the transcatheter atrial septal defect occluder during the early period. Mean age was 25.5 years (15–45) and 3 of the patients were female (50%). The diagnosis was made via transthoracic echocardiography (TTE) preoperatively.ResultsAll of these 6 patients underwent emergency operations. Mean postoperative intensive care unit (ICU) stay was 2.2 days and mean hospital stay was 6 days. No early or late postoperative mortality was seen. Mean postoperative follow-up time was 19.3 months (range: 5–28 months). Early- and late-period TTE examinations showed no residual interatrial shunting. One patient developed a right atrial thrombus in the postoperative 22nd month as a complication of long-term follow-up. He was treated with anticoagulant therapy for 6 months with complete resolution at the TTE.ConclusionsTranscatheter occlusion of secundum type ASD provides prominent clinical improvement, as well as a regression in dimensions of cardiac chambers. Nevertheless, this technique has drawbacks such as distal migration and residual shunts. Consequently, we think that unfavorable anatomy and device diameter are major issues in device migration. Oversizing also increases the migration risk. |
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Keywords: | Amplatzer septal occluder embolization migration secundum type atrial septal defect |
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