Journal Information
Vol. 37. Num. 2.February 2018
Pages 97-212
Share
Share
Download PDF
More article options
Visits
375
Vol. 37. Num. 2.February 2018
Pages 97-212
Image in Cardiology
DOI: 10.1016/j.repce.2018.03.005
Open Access
An extremely rare but considerably important device-related complication of percutaneous atrial septal defect closure
Uma complicação extremamente rara mas consideravelmente importante relacionada com dispositivo de encerramento percutâneo da comunicação interauricular
Visits
375
Yusuf I. Alihanoglua,
Corresponding author
aliizyu@mynet.com

Corresponding author.
, Dogu I. Kilica, Bekir S. Yildiza, Bilgin Emrecanb, Harun Evrengula
a Pamukkale University School of Medicine, Department of Cardiology, Denizli, Turkey
b Pamukkale University School of Medicine, Department of Cardiovascular Surgery, Denizli, Turkey
This item has received
375
Visits

Under a Creative Commons license
Article information
Full Text
Download PDF
Statistics
Figures (3)
Show moreShow less
Full Text

A 21-year-old male with a 27-mm atrial septal defect (ASD) underwent an uneventful percutaneous device closure using a 28-mm Ultrasept ASD Occluder with super-low profile (Cardia, Inc., USA) under transoesophageal echocardiography (TEE) guidance. We particularly favoured this kind of occluder device due to the possible future need for catheter atrial septostomy in such a young patient. The use of TEE during the procedure ensured that the occluder device was properly deployed in the middle part of the interatrial septum and there was no residual shunt through it (Figure 1). There were also no problems with the occluder device at 1-month follow-up. However, four months after the procedure, the patient presented again with vague chest pain, palpitations and shortness of breath. The physical examination was unremarkable. Transthoracic echocardiography (TTE), followed by TEE, revealed a significant left-to-right shunt, although the device was clearly seen in the middle part of the interatrial septum. The initial differential diagnosis included partial displacement of the device and therefore, the patient was referred to surgery, all margins of the occluder device were found to be properly attached 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 atrial septum was performed successfully after removing the metallic part of the device. There were no signs of emboli in the brain or pulmonary vasculature on the computed tomography scan, which was performed following the surgery for any possible embolisation of the patch material. The patient was discharged from the hospital without any complications and in good health.

Figure 1.
(0.08MB).

TEE images demonstrate that the occluder device was properly deployed in the middle part of the interatrial septum (A) and there was no residual shunt through it (B).

Figure 2.
(0.13MB).

Intraoperative imaging showing that all margins of the occluder device were properly attached to the interatrial septum and there was no displacement.

Figure 3.
(0.22MB).

Imaging of the occluder device after surgical extraction from the front (A) and the back (B) sites.

In conclusion, although device closure of ASDs can safely be performed percutaneously, recanalisation may occur on rare occasions, probably due to device characteristics of the Ultrasept ASD Occluder. While ASD occluder devices from this brand are usually preferred due to their super-low profile, this feature of the devices may not provide necessary support and resistance in the interatrial 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 interest

The authors have no conflicts of interest to declare.

Copyright © 2017. Sociedade Portuguesa de Cardiologia
Idiomas
Revista Portuguesa de Cardiologia (English edition)

Subscribe to our Newsletter

Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos